GET IT RIGHT OR OBTAIN IT CORRECTLY: THE ROLE OF READABILITY OF CONSENT FORMS IN DETERMINING DISCLOSURE RATES

Purpose:

Frequently, patients and health care providers are asked to disclose health information with explicit confidentiality assurances, embedded in lengthy, complex consent forms. However, assurances may not always have the intended effect of increasing disclosure (John et al, 2011). This ironic disclosure effect may be amplified by the complexity of the form itself.  The purpose of this work is to examine how readability and fluency of consent forms influences disclosure rates.

Method:

Participants were recruited via Crowdflower, and were asked to disclose a variety of health information. Participants were assigned to one of two consent Readability conditions: Simple (written at 7^th grade level) vs. Complex (12^thgrade level). Participants also randomly assigned to one of two Assurance conditions: Assured (explicit assurance of confidentiality) vs. Unassured (no assurance).

We examined how frequently participants made sensitive health disclosures. When participants do not feel secure, they will be less likely to admit to having personally engaged in an unsavoury health activity. We also examined “Prefer Not to Say” response selections as a proxy for opt-out.

Result:

When participants read a Complex consent form, presence or absence of a confidentiality assurance did not predict disclosure rates, p > .80. However, when participants read a Simple consent form, disclosure was more likely when assurances were explicit, p = .06. There were no significant differences in PNS responses, p> .40.

Conclusion:

Confidentiality assurances may have the desired effect of increasing trust and disclosure, but only when patients and providers are able to understand and interpret them. Implications of this work suggest that disclosure decisions, which often form the basis for medical decision making, are highly dependent on patients’ understanding of how this information is handled.