Lower reading levels benefit informed consent

A study1 published in the Journal of Cataract and Refractive Surgery, says that informed consent sheets that are concise and written at lower reading comprehension levels, as well as videotaped presentations, work well in helping patients understand the risks, benefits, and treatment alternatives to cataract surgery. The study is the result of a randomized, prospective study.

Authors of the study, Anita N. Shukla, MD, Mary K. Daly, MD, and Paul Legutko, PhD, who conducted the research at the Veterans Affairs Boston Healthcare System, said that using these tools to increased patient understanding could decrease the risk for indemnity payments awarded because of informed consent perceived to be inadequate.

The researchers chose patients who were eligible for cataract surgery, then were randomly assigned to one of four groups. Each members of all groups received conventional verbal information about informed consent. In addition, members of the second group received a brochure written on a second-grade reading level, the third group received a brochure written on an eighth-grade reading level, and the final group received an American Academy of Ophthalmology-produced patient education DVD titled "Understanding Cataract Surgery," which includes an aid to informed consent.

After the informed consent process, patients in each group were asked to answer 12 questions about cataract surgery, its benefits, its risks, and the alternatives. Patients in the groups who received materials written on the second grade reading level and who received the DVD received scores that were a great deal higher than those of patients in the other two groups. The researchers found that previous cataract surgery and education level did not significantly influence patient recall of the informed-consent process.


  1. Shukla A, Daly M, Legutko P. Informed consent for cataract surgery: Patient understanding of verbal, written, and videotaped information. J Cataract Refract Surg 2012; 38:80-84.