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 .
Involving Patients in Clinical Decisions: Impact of an Interactive Video Program on Use of Back Surgery
Background .Back surgery rates are rapidly rising in the United States . This surgery is usually elective , so patient preferences are important in the treatment decision . Objectives .The objective of this study was to determine the impact on outcomes and surgical choices of an interactive , diagnosis-specific videodisk program for informing patients about treatment choices . Research Design .This was a r and omized , controlled trial at 2 sites comparing the interactive video plus a booklet with the booklet alone . Subjects . Elective surgery c and i date s ( n = 393 ) included 171 patients with herniated disks , 110 with spinal stenosis , and 112 with other diagnoses . Measures .Mailed question naires were used to assess outcomes and satisfaction ; surgery rates were determined by question naires and automated records . Results .Symptom and functional outcomes at 3 months and 1 year were similar between study groups . The overall surgery rate was 22 % lower in the videodisk group ( 26 % versus 33 % , P = 0.08 ) . Among patients with herniated disks , those in the video group underwent significantly less surgery ( 32 % versus 47 % , P = 0.05 by Kaplan-Meier test ) . Among patients with spinal stenosis , surgery rates in the video group were higher ( 39 % for the video group , 29 % for the booklet group;P = 0.4 ) . There was little effect on patient satisfaction , but patients in the video group felt better informed . Conclusions .The program appears to facilitate decision making and may help to ensure informed consent . For patients with herniated disks , it reduced the surgery rate without diminishing patient outcomes . Its impact on costs of care depends on the proportion of patients with various diagnoses and on local surgery rates
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 .