Evaluation of a method to improve the consent process: improved data retention with stagnant comprehension.

Our study explored whether a simple, cost-effective intervention directed only at physicians could improve patient comprehension with informed consent process. In our medical university oncology clinic, we performed a baseline survey on 69 patients receiving new therapy, testing for comprehension of the important components of the informed consent process. We then instituted a three-part intervention, including (1) physician education, (2) an available toxicity list, and (3) a checklist to ensure physician compliance. We repeated the survey on 54 consecutive patients who consented for treatment, evaluating four outcomes. The intervention produced a 38 % improvement in patients' listing of toxicities (p = 0.0003) and no significant improvements in the understanding of therapeutic goals, likelihood of achieving those goals, and confidence in their understanding of treatment. Our three-part intervention, directed solely at physicians, improved patients' recall of toxicity data but did not influence the other important areas of patient comprehension within the informed consent process.

Critical evaluation of esophageal dilation in nonobstructive dysphagia with and without esophageal rings.

GOALS: To evaluate the therapeutic efficacy of esophageal dilation compared with medical treatment in patients with nonobstructive dysphagia (NOD). BACKGROUND: Clinical studies evaluating the role of esophageal dilation in patients with NOD have reported conflicting results. In addition, studies suggesting beneficial effects of esophageal dilation in this group of patients have not compared it with medical treatment. STUDY: We conducted a retrospective study in 107 patients with NOD and divided these patients into 2 groups. Group 1 included patients who received esophageal dilation with a polyvinyl bougie along with adjunctive medical treatment, and group 2 included patients who received medical treatment alone. RESULTS: Complete resolution of symptoms occurred in 41 of the 60 patients (68.3%) who received esophageal dilation. In the group that received medical treatment alone (n=47), 28 patients (59.5%) had complete resolution of symptoms. There was no statistically significant difference in symptom resolution between the 2 groups. In addition, among 22 patients with esophageal rings, 17 patients (77%) had complete symptomatic relief with dilation, as compared with 63% patients without esophageal rings. Although there was a trend towards higher frequency of dysphagia resolution with esophageal dilation in patients with NOD and esophageal rings, the difference failed to reach statistical significance. CONCLUSIONS: Esophageal dilation and medical therapy are equally efficacious (60% to 70% of cases) in resolving symptoms of dysphagia in patients with NOD. Patients with NOD and esophageal rings may represent the subgroup of patients who are more likely to benefit from esophageal dilation.