Informed consent in otologic surgery: Prospective randomized study comparing risk recall with an illustrated handout and a nonillustrated handout

Objective: Following consent, do pictures in a handout improve patients' recall of otologic surgical risks? Study Design: Prospective, randomized trial in a tertiary care centre. Methods: Patients undergoing otologic surgery were consented with a standardized checklist of risks by two surgeons. They were randomized (stratified by educational level) to receive either a pure text or a text and pictures handout outlining the risks of surgery. A telephone interview tested recall at a mean of 19 days. Twenty-six patients were resampled at 1 year. Main Outcome Measures: Recall was analyzed with respect to type of handout, age, sex, and level of education. A subset of 31 patients was analyzed for the effects of which surgeon consented, previous otologic surgery, and actually reading the handout. Results: Fifty-one patients completed the study. The overall risk recall was 43%, with 45% in the pictorial group and 42% in the pure text group (p = .84). The illustrated handout did not improve the recall of any individual surgical risk either. Higher education improved risk recall from 36 to 54% (p = .009). Age, consenting surgeon, previous otologic surgery, and even reading the handout did not improve risk recall. A subgroup of 26 patients was followed up 1 year later, and their recall fell from 41 to 35%. The illustrated handout did not improve long-term recall (p = .674). Conclusion: Pictorial cues do not improve recall of surgical risks, but education level does.