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J Patient Saf. 2014 Sep;10(3):140-5. doi: 10.1097/PTS.0b013e3182a00317.

Patient perceptions of surgical informed consent: is repeat back helpful or harmful?

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From the *Denver VAMC, Denver; †University of Colorado Health Outcomes Program, Aurora, Colorado; ‡Atlanta VAMC, Decatur; §Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; ∥Baylor College of Medicine, Operative Care Line Executive, Michael E. Debakey VAMC, Houston, Texas; ¶Boston VA Health Care System, Boston University and Harvard Medical School, Boston, Massachusetts; **Portland VAMC and Department of Surgery, Oregon Health Science University, Portland, Oregon; ††Pittsburgh VAMC and Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; ‡‡Tampa VAMC and Department of Surgery, University of South Florida, Tampa, Florida; and §§Department of Psychology, University of Alabama, Tuscaloosa, Alabama.



Informed consent (IC)comprehension is suboptimal. Repeat back (RB)-asking the patient to repeat in their own words key elements of the consent-is believed to improve the consent process.


This study aims to assess the impact of RB on patient perceptions of surgical informed consent.


Secondary analysis of a randomized trial.


Elective surgical patients were consented using iMedConsent, the VA's computer-based IC platform. Patients were randomized to RB (IC could not be signed until the patient satisfactorily expressed key elements) or standard iMedConsent (no RB).


A questionnaire was given immediately after IC assessing time for decision, satisfaction with and ease of understanding consent, and the amount of information provided about the proposed surgery (e.g., indications, benefits, risks, and alternatives). Groups were compared with Χ tests.


We enrolled 575 subjects (276 RB and 299 no RB); 92% were men with a mean age of 61.6 years and high school level reading ability. The groups were comparable in their perceptions regarding time to make a decision (RB 88% Strongly Agree (SA), no RB 88% SA; P = 0.61), satisfaction with consent (RB 90% SA, no RB 87% SA; P = 0.27), ease of understanding (RB 69% SA, no RB 67% SA; P = 0.73) receipt of the right amount of information regarding the indications (RB 85% SA, no RB 87%; P = 0.61), the benefits (RB 87% SA, no RB 86% SA; P = 0.29), and the risks (RB 87% SA, no RB 84% SA; P = 0.19) of surgery. More of the RB group felt they received the right amount of information about alternatives to surgery (RB 80% SA) than did the no RB group (69% SA); P = 0.01.


Patients were highly satisfied with RB during surgical IC RB is not detrimental to the consent process and may improve informed consent for surgery.


Clinical Trials Identifier NCT00288899

[Indexed for MEDLINE]

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