title: Informed consent: do information pamphlets improve post-operative risk-recall in patients undergoing total thyroidectomy: prospective randomized control study.
abstract: BACKGROUND
  Informed consent consists of basic five elements: voluntarism, capacity, disclosure, understanding, and ultimate decision-making. Physician disclosure, patient understanding, and information retention are all essential in the doctor-patient relationship. This is inclusive of helping patients make and manage their decisions and expectations better and also to deal with any consequences and/or complications that arise. This study investigates whether giving patients procedure-specific handouts pre-operatively as part of the established informed consent process significantly improves overall risk-recall following surgery. These handouts outline the anticipated peri-operative risks and complications associated with total thyroidectomy, as well as the corrective measures to address complications. In addition, the influence of potential confounders affecting risk-recall, such as anxiety and pre-existing memory disturbance, are also examined.
  
  
  METHODS
  Consecutive adult (≥18 years old) patients undergoing total thyroidectomy at a single academic tertiary care referral centre are included. Participants are randomly assigned into either the experimental group (with pamphlets) or the control group by a computerized randomization system (Clinstat). All participants filled out a Hospital Anxiety and Depression Scale (HADS) and they are tested by the physician for short-term memory loss using the Memory Impairment Screen (MIS) exam. All patients are evaluated at one week post-operatively. The written recall questionnaire test is also administered during this clinical encounter.
  
  
  RESULTS
  Forty-nine patients are included--25 of them receive verbal consent only, while another 24 patients received both verbal consent and patient education information pamphlets. The overall average of correct answers for each group was 83% and 80% in the control and intervention groups, respectively, with no statistically significant differences. There are also no statistically significant differences between the two groups, in both interview duration, in time between interviews, and in recall tests. No correlation is also apparent between the pre-op HADS score and the recall questionnaire overall score.
  
  
  CONCLUSIONS
  A pre-operative thyroid surgical information pamphlet alone might not be sufficient to enhance patient test scores and optimally educate the patient on their expected care pathway in thyroid surgery. Supplementation with alternative means of patient education perhaps using emerging technologies needs to be further investigated.
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. haskfu2@yahoo.com.
authors.forename: Hussain
authors.initials: H
authors.lastname: Alsaffar
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. lwilson6@lakeheadu.ca.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Wilson
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. dkamdar@nshs.edu.
authors.forename: Dev P
authors.initials: DP
authors.lastname: Kamdar
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. faizullo.sultanov@gmail.com.
authors.forename: Faizullo
authors.initials: F
authors.lastname: Sultanov
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. danny.enepekides@sunnybrook.ca.
authors.forename: Danny
authors.initials: D
authors.lastname: Enepekides
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. kevin.higgins@sunnybrook.ca.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Higgins
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D008297:Male; D011939:Mental Recall / Q000502:physiology*; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D010817:Physician-Patient Relations; D011183:Postoperative Complications / Q000517:prevention & control* / Q000523:psychology; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013965:Thyroidectomy / Q000009:adverse effects* / Q000523:psychology