Can patients read what they are signing? A test of consent form readability among ophthalmic patients

Abstract

Purpose: Difficulty reading consent forms and healthcare instructions may contribute to worse patient education and jeopardize health outcomes. Here, we assessed reading parameters in a group of patients undergoing ophthalmic and non-ophthalmic surgery.

Methods: 138 patients undergoing ophthalmic surgery and 138 patients undergoing outpatient non­ophthalmic surgery at a single institution were enrolled. Reading acuity, reading speed, and critical print size were measured using the MNRead chart with the patient wearing the same correction used when signing their anesthesia consent form. Critical print size (CPS) was defined as the smallest print size that supported a reading speed of at least 50% of the average of the participant’s three fastest reading speeds on MNRead chart sentences.

Results: Average logMAR reading acuity was 0.35 (0.32) and -0.05 (0.28) amongst the ophthalmic and non-ophthalmic surgery patients, respectively, and 54% of ophthalmic surgery patients and 95% of non-ophthalmic surgery patients had a logMAR reading acuity better than 0.4 (the print size of the consent material). Average logMAR CPS was 0.37 (0.28) and 0.03 (0.22) amongst the ophthalmic and non-ophthalmic surgery patients, respectively, and 51% of ophthalmic surgery patients and 7% of non-ophthalmic surgery patients had a logMAR CPS worse than 0.4 (the print size of the consent material). Average maximum reading speeds were 199 (77) wpm and 286 (119) wpm amongst ophthalmic and non-ophthalmic surgery patients respectively. Twenty one percent of ophthalmic surgery patients and 4% of non-ophthalmic surgery patients had a reading speed below 100 wpm at the print size of the consent material. Among these patients, the average reading speed was 52 (29) wpm and 63 (37) wpm amongst ophthalmic and non-ophthalmic surgery patients, respectively. However, all of these patients demonstrated maximum reading speeds >125 wpm.

Conclusions: Preoperative consent form reading may frequently be challenging, particularly amongst patients undergoing ophthalmic surgery. However, nearly all patients are likely to read at functional speeds with adequately sized text. Our results suggest that many ophthalmic and non-ophthalmic patients may not properly assimilate written healthcare information, and may benefit from larger print consent forms and healthcare instructions.