Informed consent for cataract surgery—what is best practice?

To test the basic knowledge of population pertaining to cataract and its treatment and to determine the best method among conventional written, audiovisual and oral presentation by surgeon for informed consent before cataract surgery.

Randomized prospective study at the JN Medical College, AMU Aligarh. Patients were divided into 3 groups and pretested by a 12 point multiple choice questionnaire for baseline knowledge. They were subjected to informed consent by conventional written material or audiovisual aid along with written aid or by oral presentation by surgeon along with written and audiovisual aids respectively. Post-test by same questionnaire was taken to find out gain, retention and recall of knowledge by the patient and identify the best consent practices for cataract surgery.

Of the 126 patients enrolled, 3 randomized groups of 42 each were pretested and administered informed consent. The baseline knowledge of patients was similar before consent in all three groups with mean scores at 4.5, 4.5 and 4.7 (P>0.05), and increased significantly after the consent process in all the groups with mean scores at 7.2, 8.2 and 9.3 out of 12 respectively (P<0.001). The increase in level of knowledge was maximum in Group 3 (surgeon's oral presentation with audiovisual and conventional written aids) compared to Group 1(conventional written aid only) and Group 2 (conventional written and audiovisual aids) (P<0.001).

The significant increase in post test scores of patients after informed consent reaffirms the value of detailed consent in elective surgeries like cataract. Combination of conventional written consent with audiovisual aids and oral presentation by surgeon is the best method to administer informed consent. This will educate patients to take informed self-care decisions and can reduce healthcare services burden by postponing unnecessary surgeries and minimize negligence claims and indemnity issues.