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Improving Patient-Provider Communication for Patients Having Surgery: Patient Perceptions of a Revised Health Literacy-Based Consent Process

Miller, Michael J. RPh, DrPH*; Abrams, Mary Ann MD, MPH; Earles, Barb RN, MHA, CPHRM; Phillips, Kirk PhD; McCleeary, Erin M. PharmD

doi: 10.1097/PTS.0b013e31820cd632
Original Articles

Objectives: This research sought to describe and compare perceptions of consent-related health communication between surgical patients undergoing procedures at facilities that did and did not adopt a new health literacy-based consent form and process.

Methods: A self-administered, mail survey was used to collect information about demographic characteristics, health locus of control, and perceptions of surgical consent-related health communication from patients aged 18 years or older, approximately 2 to 4 months after undergoing laparascopic cholecystectomy, total hip replacement, or total knee replacement surgery within a 10-hospital integrated health system in Iowa. A static group comparison design with multivariable logistic regression analyses was used to compare perceptions about 12 aspects of surgical consent-related health communication between the adopting and nonadopting facilities while controlling for observed differences in respondent background characteristics using a threshold of P < 0.05 for model inclusion.

Results: Respondents from facilities implementing the new consent form and process had significantly higher odds of strongly agreeing that the nurses asked them to restate the type of surgery being performed in their own words (adjusted odds ratio, 1.92; 95% confidence interval, 1.30-2.82) and they were comfortable asking questions about their surgery (adjusted odds ratio, 1.53; 95% confidence interval, 1.04-2.26).

Conclusions: The consent process can be refined to stimulate communication and comfort with asking questions, and promote use of health literacy-based techniques (i.e., teach-back) in the perioperative care setting. Adopting a health literacy-based informed consent process promotes patient safety and supports health providers' obligations to communicate in simple, clear, and plain language.

From the *College of Pharmacy, The University of Oklahoma, Tulsa, Oklahoma; †Iowa Health System, Des Moines, Iowa; and ‡Avera McKennan Hospital & University Health Center, Sioux Falls, South Dakota.

Correspondence: Michael J. Miller, RPh, DrPH, College of Pharmacy-Tulsa, The University of Oklahoma, 4502 East 41st St, Tulsa, OK 74135 (e-mail:

Grant Support: This study was supported, in part, by the Community Responsive Grant Program through the Wellmark Foundation, Des Moines, Iowa.

Conflict of Interest: None.

© 2011 Lippincott Williams & Wilkins, Inc.