Enhancement of the informed consent documents: suggestions about legibility, readability and text coherence

Year 2017, , 141 - 142, 23.06.2017

Nuri Erdoğan Hakan İmamoğlu

https://doi.org/10.17098/amj.308640

Abstract

Dear Editor,

The initial step in
the informed consent (IC) process is the disclosure of information to the
patient. The information can be disclosed by means of personal communication,
multimedia interventions, or through the use of a written material. From the
perspective of law, it is necessary that the content of the patient-physician
communication should be documented and signed by both parties. Therefore,
information disclosure through a written document is the preferred method of
conduct in most healthcare institutions. However, although this approach provides
official recording, it bears other difficulties: The text presented to the
patients should be legible, readable and coherent in itself.

In patients with presbyopia
or other difficulties in sight, the problems about legibility can be overcome
by following the American Printing House guidelines for print
document design.¹
Text coherence may require modifications with reference to 1. logical/semantic
associations and; 2. grammatic associations between successive sentences; 3. proper
use of the conjunctions; 4. contextual relations between parts of the text; and
5. establishment of the overall thematic integrity.² Finally, enhancement
of the readability requires assessment formulas which are specific to that
language.

In case of Turkish
language, to our knowledge, there is only one formula that fulfills the
requirements of a scientific approach: Çetinkaya-Uzun Readability Formula.³
The readability score in this formula is defined as

Readability Score=118.8-25.9xAWL-0.9xASL

where AWL is the
Average Word Length, and ASL is the Average Sentence Length. Based on multiple
regression analysis, the formula also provides years of schooling that
correspond three categories of readability levels: Readability scores ≥51
correspond to 5-7 years; scores 35–50 correspond to 8-9 years; and scores 0-34
correspond to 10 or more years of schooling, which is the category of
independent reading. Regardless of the language, any readability formula which
provides such a categorical approach in schooling gives an additional insight
about the IC practice: Patients below the category of independent reading (e.g.
Turkish patients with schooling level of 9 years or less according to Çetinkaya-Uzun
Readability Formula), are prone to misconduct in IC process, therefore increasing
the liability of physicians. This group of patients can be easily discriminated
by asking his/her last year in schooling.

In conclusion, the
above mentioned suggestions may help the researchers who are interested in
enhancement of the IC documents with regard to legibility, readability and text
coherence. In addition to its function as an assessment tool, any reading
formula which provides a categorical approach for independent reading also
serves to identify the patients at risk for IC misconduct. 

Keywords

Informed consent, legibility, readability, text coherence

Bilgilendirilmiş onam belgelerini geliştirme: açıklık, okunabilirlik ve metin tutarlılığı hakkında öneriler

Abstract

References

• American Printing House guidelines for print document design [Internet]. American Printing House. Available from: http://www.aph.org/research/design-guidelines/ , (Date of Access: 4th April 2017).
• Ülper H. Öğrenci metinlerinin tutarlılık ölçütleri bağlamında değerlendirilmesi. Turkish Studies 2011;6:849-63.
• Çetinkaya G, Uzun GL. Identifying and Classifying The Readability Levels of Turkish Texts. ATINER'S Conference Paper Series, No: LIT2012-0281. Athens, Greece: Athens Institute for Education and Research;2012.