A detailed informed consent process is important before the start of any orthodontic treatment, but a study presented at the recent International Association for Dental Research (IADR) conference in San Diego found that reducing the volume of information can actually increase efficiency.
Previous research on orthodontic informed consent found low patient/parent recall and comprehension of treatment risks and expectations, noted the study authors.
The current research was a follow-up to a previous study in the American Journal of Orthodontics and Dentofacial Orthopedics (AJA-DO, October 2009, Vol. 136:4, pp. 488.e1-13), which examined methods to improve recall and understanding of orthodontic informed consent, explained lead author Kelly Carr, DDS, a resident in the department of orthodontics at the Ohio State University College of Dentistry.
That study, which compared the American Association of Orthodontists (AAO) informed consent form and other forms that incorporated improved readability and processability, found that reformatting the consent form to make it more readable and pairing it with an audiovisual presentation improved recall and understanding.
"It far surpassed the standard method using the AAO consent form, but it was far from perfect and left room for improvement," Dr. Karr said. "The current study attempted to reduce the verbal explanation of risks, benefits, etc."
Repetition not effective
To determine the effectiveness of using customized informed consent documents with and without verbal explanation, Dr. Karr and her colleagues looked at 48 parent/patient pairs who were randomly assigned to one of two groups.
Group 1 listened to a resident case presentation of the treatment plan and the key points of informed consent. Each subject then read the modified informed consent form and reviewed a customized PowerPoint (PPT) presentation generated for each subject-pair based on the most common risk factors (pain, enamel destruction, root resorption, and post-treatment change) and up to four patient-specific risk factors. Group 1 then completed an interview with structured questions, two reading ability tests, and a demographics questionnaire.
— Kelly Carr, DDS
Group 2 had the same intervention, except subjects did not have the verbal explanation of the key points of consent.
The authors found no significant differences between the groups for recall, comprehension, and recall/comprehension combined.
"This pilot study suggests no advantage to a verbal review of the informed consent form at the case presentation when other means of review such as the customized PPT are included," they noted. "Eliminating this verbal review could increase provider efficiency during the orthodontic informed consent process."
While these findings validate the method established in the 2009 AJA-DO study, a shorter method may be equally informative because subjects are not as fatigued by the process, the authors added.
While it is likely that orthodontists explaining the planned orthodontic treatment would verbally highlight those concepts of particular importance to a specific patient, this provided no additional benefit, they noted.
"Undue repetition does not appear to be warranted," they wrote.
Less is more
Changing the informed consent approach by reducing the material volume, pairing written and audio visual presentations, and focusing on common, patient-specific issues may help patients and should be investigated, Dr. Karr explained.
"Repetition of information could be reduced except for some risk information," she said. "Less is more when volume is concerned with some aspects of informed consent."
H. Asuman Kiyak, PhD, a professor of oral and maxillofacial surgery at the University of Washington and a co-author of the study, told DrBicuspid.com that it is very important to improve informed consent procedures in this type of dentistry, which, unlike 90% of dentistry, is a long-term process with lots of potential complications and undesirable outcomes.
These findings are part of ongoing research being done at Ohio State University to develop a better tool for informed consent, Kiyak explained.
For now, the take-away message is that orthodontists should not assume that patients understand what they are being told about procedures they will undergo even if the patients keep nodding their head.
"Most important is to help patients understand why the orthodontist is recommending a particular type of procedure, and perhaps to make sure the patient has truly made an informed decision about undergoing this versus alternative versus no treatment," Kiyak concluded.
