The Reading Level of Surgical Consent Forms in Hand Surgery

Abstract

Purpose: The average United States adult reads at an eighth-grade reading level. In an effort to ensure that patients understand written medical information, the National Institutes of Health and American Medical Association suggest that patient-directed material be written at a sixth- to eighth-grade reading level. We hypothesized that the mean reading level of surgical consent forms for hand surgery is not at or below an eighth-grade reading level (the suggested maximum from the National Institutes of Health). Methods: We conducted a retrospective review of consecutive consent forms used for hand surgery patients from 7 hand surgeons at our institution from June, 2017 to October, 2017. Consent forms were reviewed to collect the hand-written portion describing the procedure. We also assessed our institution’s consent form template. This text was assessed for readability and reading level with the following tools: Flesch-Kincaid Grade Level and Flesch Reading Ease. We categorized the procedures written on each consent form by procedure type and then created simplified language for the same procedure below an eighth-grade reading level. Results: Mean Flesch-Kincaid grade level of all consent forms was 10.5 (SD, 5.8) and mean Flesch readability was 33.6 (SD, 38.8), or difficult to read. A total of 78% and 58% of forms were written above the sixth- and eighth-grade reading levels, respectively. Readability was remarkedly poor; 94% and 88% of consent forms were written above sixth- and eighth-grade readability, respectively. The grade level of the consent form template was 17.1. Conclusions: Most consent forms were written above a sixth- to eighth-grade reading level and may not have been well-understood by patients. It is possible for physicians to write on surgical consent forms at a reading level that patients are more likely to understand by opting for less specialty-specific words and writing in shorter sentences. Improving the readability of patient-directed materials is an approach to improving patient-centered care. Type of study/level of evidence: Prognostic IV. Key words: hand surgery, readability, reading level, surgical consent form, upper-limb surgery