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Informed consent: optimism versus reality M. A. Mohamed Tahir, C. Mason and V. Hind Br Dent J 2002; 193: 221–224

Comment

The survey attempts to evaluate the quality of understanding and feedback in a relatively controlled environment using an out-patient GA clinic where the issues of consent could be streamlined, namely an understanding of the type of anaesthesia that will be used during extractions, the number of teeth that would be extracted and the type of teeth that will be extracted (primary or permanent teeth). By interviewing the parents immediately after the primary assessment appointment and again approximately a week later, just before the treatment appointment, the interviewer can determine how much information had been retained at the time of giving the consent and at the time of treatment. The restricted information required for the type of treatment being provided, namely GA extractions, allowed the interviewer to focus on the issues of understanding and retention of information.

The results demonstrate two specific issues relating to consent. The first is the importance of efforts made to ensure that parents understand the treatment to be provided. Apparently at least one third did not understand all the relevant details of the treatment in spite of a specific discussion with the dentist involved in agreeing the treatment. The signing of a consent form under those circumstances must be of little value and indeed could be a distraction from the real issue which is the failure to put the information to the patient and audit feedback to determine that the patient or parent has understood the treatment. It highlights the need to ensure that information is provided in a simple format in lay terms and in a 'language' which the patient can understand. In this survey for a number of patients English was not the first language and this added to the difficulties.

The second issue was that there was a slight increase in understanding just before the treatment at the second appointment. This is the reverse of what is generally believed to be true and was explained by the authors as possibly because subjects were involved in the study and possibly because of reinforcement of the consenting process by the staff carrying out the pre-anaesthetic assessment. It does highlight that an opportunity exists to reinforce the message in validating consent, and where complex treatment is to be undertaken, a space between the original discussion of the actual treatment appointment could well have value if it is followed up properly with a further discussion immediately prior to treatment. Whilst this survey demonstrates that it is very easy for dentists to assume a parent (and therefore patients) understands treatment, it is clear approximately two out of three did not understand all the details involved. An assumption can therefore be made that patients find it difficult to understand and every effort should be made by dentists to provide information in the most easily digestible format available. It would also be helpful if prior to treatment the details of the treatment, outcome, sequelae, etc were reinforced. The importance of clear records demonstrating the consenting process would not only guide the dentist through the appropriate steps but also confirm that those steps had been undertaken.