An interesting article titled “Patient Recall of Information on a Third Molar Informed Consent Video,” written by Olsen et al. appears in the Journal of Oral and Maxillofacial Surgery in 2017 (vol. 75, pp. 2507-2511). The article sought to explore how much of an informed consent video for wisdom teeth surgery patients remember.
The authors were motivated to conduct the study due to how recent court cases and lawsuits have played out. Patients will often deny that certain information was provided to them in an attempt to show malpractice by the surgeon. In most informed consent processes for patients having wisdom teeth removal they view an informed consent video, have a discussion with the surgeon about information provided, and then acknowledge having done so by signing a printed document that discusses the risks and benefits of surgery. Since some of these patients claim to not have received pertinent information the authors were working under the assumption that most patients would only remember a certain amount of the information given.
As such the authors devised a study where 50 patients presenting at the oral and maxillofacial surgery clinic of the Virginia Commonwealth University (VCU) School of Dentistry and 50 patients presenting at a private oral and maxillofacial surgery office viewed an 11-minute informed consent video. The video sought to educate the patients about impacted wisdom teeth, treatment options, postoperative side effects, postoperative care, and anesthetic options and side effects. After viewing the video patients met with their treating surgeon and any questions were discussed. Next the patients were given a 10-item questionnaire that contained true-or-false questions about the benefits, risks, and complications related to wisdom teeth extraction. At some day in the future prior to surgery the patients were asked to again complete the same 10-item questionnaire.
The authors found that there was a decrease in the overall percentage of questions answered correctly from the questionnaire given on the same day as viewing the video and talking with the surgeon when compared to the questionnaire given at a another day after (from 93.2% to 89.5% – a value that is statistically significant). In particular three of the ten questions gave the patients more trouble: 1) Impacted teeth must always be removed? 2) If you have light sedation rather than general anesthesia, you do not need to have someone drive you home? and 3) Impacted teeth can give rise to cysts and tumors in the jaw?. These three questions had a statistically significant decrease in the correct answer between baseline and follow-up while the other seven question did not have any statistically significant decreases. Using a two-way analysis of variance the author found that baseline scores were on average 0.37 points higher than follow-up scores and patients who went to a private practice scored on average 0.43 points higher than those at VCU. These results were statistically significant with a p-value of 0.0212 for time and 0.0076 for the practice setting.
The authors state
“The informed consent process for third molar [wisdom teeth] surgery is important not only because it is designed to provide information to the patient that will help avoid intraoperative and postoperative complications, but also because it helps patients to understand the potential benefits and risks of the intended surgery. Therefore, it is essential that patients remember the information that is provided.”
As a result of their study the authors feel as a whole that there was not any a failure to remember some of the information the patients were given initially and that there was no increase in the amount of information one could not remember after being removed from the informed consent process.
The authors state:
“Not only were patients able to answer a large percentage of questions on the baseline and follow-up evaluations correctly, but also, importantly, this included the questions about potentially serious complications such as nerve injury… and jaw fracture…which are most often involved in malpractice litigation.”
It is important to note that the average time between the two evaluations was statistically different between the two groups: where private practice patient had an average of 35 days between evaluations and those at VCU had an average of 18 days between evaluations. Even so there were a few questions the patients struggled with and the authors feel a presurgical review of the information provided at informed consent can be helpful.
1 thought on “Patient Recall During Informed Consent for Wisdom Teeth Surgery”