We have identified efforts by research ers to investigate interventions which seek to improve information delivery and consideration of information to enhance  informed consent .
The interventions used consistently improve patient knowledge , an important prerequisite for informed consent .
This is encouraging and these measures could be widely employed although we are not able to say with confidence which types of interventions are preferable .
Our results should be interpreted with caution due to the high levels of heterogeneity associated with many of the main analyses although we believe there is broad evidence of beneficial outcomes for patients with the pragmatic application of interventions .
BACKGROUND Achieving informed consent is a core clinical procedure and is required before any surgical or invasive procedure is undertaken .
However , it is a complex process which requires patients be provided with information which they can underst and and retain , opportunity to consider their options , and to be able to express their opinions and ask questions .
There is evidence that at present some patients undergo procedures without informed consent being achieved .
OBJECTIVES To assess the effects on patients , clinicians and the healthcare system of interventions to promote informed consent for patients undergoing surgical and other invasive healthcare treatments and procedures .
AUTHORS ' CONCLUSIONS Informed consent is an important ethical and practical part of patient care .
Making choices for childbirth: a randomized controlled trial of a decision-aid for informed birth after cesarean.
BACKGROUND Decision-making about mode of birth after a cesarean delivery presents challenges to women and their caregivers and requires a balance of risks and benefits according to individual circumstances . The study objective was to determine whether a decision-aid for women who have experienced previous cesarean birth facilitates informed decision-making about birth options during a subsequent pregnancy . METHOD A prospect i ve multicenter r and omized controlled trial of 227 pregnant women was conducted within 3 prenatal clinics and 3 private obstetric practice s in New South Wales , Australia . Women with 1 previous cesarean section and medically eligible for trial of vaginal birth were recruited at 12 to 18 weeks ' gestation ; 115 were r and omized to the intervention group and 112 to the control group . A decision-aid booklet describing risks and benefits of elective repeat cesarean section and trial of labor was given to intervention group women at 28 weeks ' gestation . Main outcome measures included level of knowledge , decisional conflict score , women 's preference for mode of birth , and recorded mode of birth . RESULTS Women who received the decision-aid demonstrated a significantly greater increase in mean knowledge scores than the control group ( increasing by 2.17 vs 0.42 points on a 15-point scale ) ( p < 0.001 , 95 % CI for difference = 1.15 - 2.35 ) . The intervention group demonstrated a reduction in decisional conflict score ( p < 0.05 ) . The decision-aid did not significantly affect the rate of uptake of trial of labor or elective repeat cesarean section . Preferences expressed at 36 weeks were not consistent with actual birth outcomes for many women . CONCLUSION A decision-aid for women facing choices about birth after cesarean section is effective in improving knowledge and reducing decisional conflict . However , little evidence suggested that this process led to an informed choice . Strategies are required to better equip organizations and practitioners to empower women so that they can translate informed preferences into practice . Further work needs to examine ways to enhance women 's power in decision-making within the doctor-patient relationship
We have identified efforts by research ers to investigate interventions which seek to improve information delivery and consideration of information to enhance  informed consent .
The interventions used consistently improve patient knowledge , an important prerequisite for informed consent .
This is encouraging and these measures could be widely employed although we are not able to say with confidence which types of interventions are preferable .
Our results should be interpreted with caution due to the high levels of heterogeneity associated with many of the main analyses although we believe there is broad evidence of beneficial outcomes for patients with the pragmatic application of interventions .
BACKGROUND Achieving informed consent is a core clinical procedure and is required before any surgical or invasive procedure is undertaken .
However , it is a complex process which requires patients be provided with information which they can underst and and retain , opportunity to consider their options , and to be able to express their opinions and ask questions .
There is evidence that at present some patients undergo procedures without informed consent being achieved .
OBJECTIVES To assess the effects on patients , clinicians and the healthcare system of interventions to promote informed consent for patients undergoing surgical and other invasive healthcare treatments and procedures .
AUTHORS ' CONCLUSIONS Informed consent is an important ethical and practical part of patient care .