A Well-understood Surgical Informed Consent : A Scoping Review
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Abstract
The implementation of surgical consent has shifted from simply getting a signature to a focus on doctor-patient communication. Providing adequate information is very important for patients in making decisions so that patients do not feel forced to agree. Good understanding is required before a patient gives consent, but many patients have difficulty understanding and doctors fail to provide correct information. The aim of this scoping review is to investigate and evaluate patient comprehension of surgical informed consent provided by standard procedure or other methods and factors affecting patient comprehension. Three electronic database searches (ProQuest, ScienceDirect, and Scopus) were performed from 2017 until 2022. A total of 391 articles were identified and 25 articles were selected according to the PRISMA guidelines and the PCC framework. 9 of 11 articles stated that patient understanding level was low. Factors that influence it include education level, age and language limitations. 12 studies (85%) showed that patient understanding improved with the use of additional information media. Overall patient comprehension of surgical informed consent is low. This depending on the communication between the doctor and the patient. An interesting interventions can be used to improve patient understanding of surgical informed consent
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How to Cite
Budi, R., & Wibowo, A. (2023). A Well-understood Surgical Informed Consent : A Scoping Review. Unnes Journal of Public Health, 12(1), 21-32. https://doi.org/10.15294/ujph.v12i1.57731
References
Agozzino, E. et al. (2019) ‘Does written informed consent adequately inform surgical patients? A cross sectional study’, BMC Medical Ethics, 20(1), pp. 4–11. doi: 10.1186/s12910-018-0340-z.
Alvionita, V., Harahap, J. and Aini, N. (2021) ‘Analysis of the Implementation of Informed Consent’, Journal of Healthcare Technology and Medicine, 7.
Axelrod, D. A. et al. (2017) ‘Cultural competency of a mobile, customized patient education tool for improving potential kidney transplant recipients’ knowledge and decision-making’, Clinical Transplantation, 31(5), pp. 1–9. doi: 10.1111/ctr.12944.
Bazzano, L. A., Durant, J. and Brantley, P. R. (2021) ‘A modern history of informed consent and the role of key information’, Ochsner Journal, 21(1), pp. 81–85. doi: 10.31486/toj.19.0105.
Benning, A. et al. (2021) ‘Patients understanding of terminology commonly used during combined orthodontic-orthognathic treatment’, Surgeon, 19(5), pp. e193–e198. doi: 10.1016/j.surge.2020.09.012.
Chia, C. L. K. et al. (2019) ‘Assessing adequacy of informed consent for elective surgery by student-administered interview’, ANZ Journal of Surgery, 89(6), pp. 677–682. doi: 10.1111/ans.15214.
Cocanour, C. S. (2017) ‘Informed consent—It’s more than a signature on a piece of paper’, American Journal of Surgery, 214(6), pp. 993–997. doi: 10.1016/j.amjsurg.2017.09.015.
Dewar, S. R., Pieters, H. C. and Fried, I. (2021) ‘Surgical Decision-Making for Temporal Lobe Epilepsy: Patient Experiences of the Informed Consent Process’, Frontiers in Neurology, 12(December), pp. 1–12. doi: 10.3389/fneur.2021.780306.
Fink, A. S. et al. (2010) ‘Predictors of Comprehension during Surgical Informed Consent’, Journal of the American College of Surgeons, 210(6), pp. 919–926. doi: 10.1016/j.jamcollsurg.2010.02.049.
Fudman, D. I. et al. (2019) ‘Effect of Consent and Educational Adjuncts to Consent on Patient Perceptions about Colonoscopy’, Journal of Clinical Gastroenterology, 53(8), pp. e316–e321. doi: 10.1097/MCG.0000000000001093.
García-García, E. M. et al. (2019) ‘Sociodemographic factors affecting the comprehension of clinical information by inpatients undergoing trauma surgery’, Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 63(5), pp. 355–360. doi: 10.1016/j.recote.2019.04.005.
Hall, D. E. et al. (2012) ‘Informed consent for inguinal herniorrhaphy and cholecystectomy: Describing how patients make decisions to have surgery’, American Journal of Surgery, 204(5), pp. 619–625. doi: 10.1016/j.amjsurg.2012.07.020.
Herfiyanti, L. (2015) ‘Kelengkapan Informed Consent Tindakan Bedah Menunjang Akreditasi Jci Standar Hpk 6 Pasien Orthopedi’, Jurnal Manajemen Informasi Kesehatan Indonesia, 3(2), pp. 81–88. doi: 10.33560/.v3i2.89.
Khan, R. I. (2012) ‘Patient Safety and the Importance of Informed Consent’, in Urolithiasis: Basic Science and Clinical Practice. Springer, London, pp. 543–546. doi: 10.1007/978-1-4471-4387-1_68.
Khoshrang, H. et al. (2021) ‘Research Paper: The Quality of Informed Consent Obtaining Before Electroconvulsive Therapy: A Report From a Referral, Academic Hospital’, Caspian Journal of Neurological Sciences, 7(1), pp. 37–41. doi: 10.32598/CJNS.7.24.6.
Kinman, C. L. et al. (2018) ‘Use of an iPadTM application in preoperative counseling for pelvic reconstructive surgery: a randomized trial’, International Urogynecology Journal, 29(9), pp. 1289–1295. doi: 10.1007/s00192-017-3513-2.
Koong, J. K. et al. (2021) ‘The effectiveness of handout assisted versus verbal consent on post-operative recall and understanding - A randomized control study’, Surgeon, (xxxx), pp. 1–8. doi: 10.1016/j.surge.2021.04.002.
Lemmu, B. et al. (2020) ‘Knowledge and Perception of Ethiopian Surgical Patients to Informed Consent Practice for Surgical Procedures’, Open Access Surgery, 13, pp. 65–70. doi: http://dx.doi.org/10.2147/OAS.S268009.
Li Ching Ng, A. et al. (2021) ‘Consent for spine surgery: an observational study’, ANZ Journal of Surgery, pp. 1220–1225. doi: 10.1111/ans.16348.
Lin, Y. K. et al. (2017) ‘Development and pilot testing of an informed consent video for patients with limb trauma prior to debridement surgery using a modified Delphi technique’, BMC Medical Ethics, 18(1), pp. 1–12. doi: 10.1186/s12910-017-0228-3.
Lin, Y. K. et al. (2019) ‘How to effectively obtain informed consent in trauma patients: A systematic review’, BMC Medical Ethics, 20(1). doi: 10.1186/s12910-019-0347-0.
Marcus, H. J. et al. (2018) ‘Informed Consent for Patients Undergoing Transsphenoidal Excision of Pituitary Adenoma: Development and Evaluation of a Procedure-Specific Online Educational Resource’, World Neurosurgery, 118, pp. e933–e937. doi: 10.1016/j.wneu.2018.07.102.
Moeini, S., Shahriari, M. and Shamali, M. (2020) ‘Ethical challenges of obtaining informed consent from surgical patients’, Nursing Ethics, 27(2), pp. 527–536. doi: 10.1177/0969733019857781.
Mudiyanselage, U. et al. (2019) ‘Are predominantly western standards and expectations of informed consent in surgery applicable to all ? A qualitative study in a tertiary care hospital in Sri Lanka’. doi: 10.1136/bmjopen-2018-025299.
Nnabugwu, I. I. et al. (2017) ‘Informed consent for clinical treatment in low-income setting: Evaluating the relationship between satisfying consent and extent of recall of consent information’, BMC Medical Ethics, 18(1), pp. 1–8. doi: 10.1186/s12910-017-0227-4.
Nuraeni, Ri. (2016) ‘Relationship of surgical procedure knowledge with level anxiety of adult surgical patients in the surgical room of cideres hospital period of May-June 2015’, Journal of nursing and health, II.
Overcarsh, P., Arvizo, C. and Harvey, L. (2019) ‘Informed consent in gynecologi surgery’, Current Opinion in Obstetrics and Gynecology, 31(4), pp. 240–244. doi: 10.1097/GCO.0000000000000550.
Pallett, A. C. et al. (2018) ‘A randomized controlled trial to determine whether a video presentation improves informed consent for hysterectomy’, American Journal of Obstetrics and Gynecology, 219(3), pp. 277.e1-277.e7. doi: 10.1016/j.ajog.2018.06.016.
Paterick, Z. R., Paterick, T. E. and Paterick, B. B. (2020) ‘Medical informed choice: Understanding the element of time to meet the standard of care for valid informed consent’, Postgraduate Medical Journal, 96(1141), pp. 708–710. doi: 10.1136/postgradmedj-2019-137278.
Perin, A. et al. (2021) ‘Informed consent through 3D virtual reality: a randomized clinical trial’, Acta Neurochirurgica, 163(2), pp. 301–308. doi: 10.1007/s00701-020-04303-y.
Pucher, P. H. et al. (2019) ‘Informing the Consent Process for Surgeons: A Survey Study of Patient Preferences, Perceptions, and Risk Tolerance’, Journal of Surgical Research, 235(0), pp. 298–302. doi: 10.1016/j.jss.2018.09.046.
Richardson, V. (2013) ‘Patient comprehension of informed consent.’, Journal of perioperative practice, 23(1–2), pp. 26–30. doi: 10.1177/1750458913023001-204.
Rouf, C. E. et al. (2017) ‘Impact of a multimedia support on the understanding of medical information by hearing-impaired patients before cochlear implantation’, European Annals of Otorhinolaryngology, Head and Neck Diseases, 134(6), pp. 387–392. doi: 10.1016/j.anorl.2017.05.001.
Ruiz López, P. (2013) ‘Informed Consent in Surgery. Distance Between Theory and Practice’, Cirugía Española (English Edition), 91(9), pp. 551–553. doi: 10.1016/j.cireng.2013.12.015.
Ruske, J. et al. (2021) ‘Patient comprehension necessary for informed consent for vascular procedures is poor and related to frailty’, Journal of Vascular Surgery, 73(4), pp. 1422–1428. doi: 10.1016/j.jvs.2020.06.131.
Sceats, L. A. et al. (2019) ‘Lost in translation: Informed consent in the medical mission setting’, Surgery (United States), 165(2), pp. 438–443. doi: 10.1016/j.surg.2018.06.010.
Shemesh, S. et al. (2019) ‘The_quality_of_informed_consent_obtained_for_ortho.pdf’, Journal ofOrthopaedic Surgery 27(2), 27(2), pp. 1–8.
Singh, A., Rochwani, R. and Oberoi, S. (2021) ‘Informed consent and responses of surgical patients: A study in North India’, National Journal of Physiology, Pharmacy and Pharmacology, 11(8), p. 1. doi: 10.5455/njppp.2021.11.06217202109072021.
Stewart, J. A. et al. (2021) ‘Visual teaching aids improve patient understanding and reduce anxiety prior to a colectomy’, American Journal of Surgery, 222(4), pp. 780–785. doi: 10.1016/j.amjsurg.2021.01.029.
Susanto, D. P., Pratama, B. S. and Hariyanto, T. (2017) ‘Analysis of Factors Affecting Patient Understanding of Informed Consent in Hospitals’, Indonesian Journal of Health Management, 5(2), pp. 73–81. doi: 10.14710/jmki.5.2.2017.73-81.
Tricco, A. C. et al. (2018) ‘PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation’, Annals of Internal Medicine, 169(7), pp. 467–473. doi: 10.7326/M18-0850.
Ulfa, H. M. (2018) ‘Analisa Kelengkapan Informed Consent Tindakan Operasi di Rumah Sakit Sansani Pekanbaru’, Jurnal INOHIM, 6(1), pp. 21–26. Available at: https://inohim.esaunggul.ac.id/index.php/INO/article/download/145/125.
Villanueva, C., Talwar, A. and Doyle, M. (2018) ‘Improving informed consent in cardiac surgery by enhancing preoperative education’, Patient Education and Counseling, 101(12), pp. 2047–2053. doi: 10.1016/j.pec.2018.06.008.
Weise, A. et al. (2021) ‘Development, piloting, and evaluation of an evidence-based informed consent form for total knee arthroplasty (EvAb-Pilot): a protocol for a mixed methods study’, Pilot and Feasibility Studies, 7(1), pp. 1–11. doi: 10.1186/s40814-021-00843-x.
Wiesen, B. M. et al. (2020) ‘Use of Surgical Risk Preoperative Assessment System (SURPAS) and Patient Satisfaction During Informed Consent for Surgery’, Journal of the American College of Surgeons, 230(6), pp. 1025-1033.e1. doi: 10.1016/j.jamcollsurg.2020.02.049.
Wong, A. L. et al. (2016) ‘The Effect of Written Information on Recall of Surgical Risks of Carpal Tunnel Release Surgery: A Randomized Controlled Study’, Plastic and Reconstructive Surgery, 138(6), pp. 1011e-1018e. doi: 10.1097/PRS.0000000000002771.
Yoon, S. H. et al. (2019) ‘Personalized 3D-Printed Model for Informed Consent for Stage I Lung Cancer: A Randomized Pilot Trial’, Seminars in Thoracic and Cardiovascular Surgery, 31(2), pp. 316–318. doi: 10.1053/j.semtcvs.2018.10.017.
Zimmermann, A. et al. (2021) ‘Written informed consent—translating into plain language. A pilot study’, Healthcare (Switzerland), 9(2). doi: 10.3390/healthcare9020232.
Alvionita, V., Harahap, J. and Aini, N. (2021) ‘Analysis of the Implementation of Informed Consent’, Journal of Healthcare Technology and Medicine, 7.
Axelrod, D. A. et al. (2017) ‘Cultural competency of a mobile, customized patient education tool for improving potential kidney transplant recipients’ knowledge and decision-making’, Clinical Transplantation, 31(5), pp. 1–9. doi: 10.1111/ctr.12944.
Bazzano, L. A., Durant, J. and Brantley, P. R. (2021) ‘A modern history of informed consent and the role of key information’, Ochsner Journal, 21(1), pp. 81–85. doi: 10.31486/toj.19.0105.
Benning, A. et al. (2021) ‘Patients understanding of terminology commonly used during combined orthodontic-orthognathic treatment’, Surgeon, 19(5), pp. e193–e198. doi: 10.1016/j.surge.2020.09.012.
Chia, C. L. K. et al. (2019) ‘Assessing adequacy of informed consent for elective surgery by student-administered interview’, ANZ Journal of Surgery, 89(6), pp. 677–682. doi: 10.1111/ans.15214.
Cocanour, C. S. (2017) ‘Informed consent—It’s more than a signature on a piece of paper’, American Journal of Surgery, 214(6), pp. 993–997. doi: 10.1016/j.amjsurg.2017.09.015.
Dewar, S. R., Pieters, H. C. and Fried, I. (2021) ‘Surgical Decision-Making for Temporal Lobe Epilepsy: Patient Experiences of the Informed Consent Process’, Frontiers in Neurology, 12(December), pp. 1–12. doi: 10.3389/fneur.2021.780306.
Fink, A. S. et al. (2010) ‘Predictors of Comprehension during Surgical Informed Consent’, Journal of the American College of Surgeons, 210(6), pp. 919–926. doi: 10.1016/j.jamcollsurg.2010.02.049.
Fudman, D. I. et al. (2019) ‘Effect of Consent and Educational Adjuncts to Consent on Patient Perceptions about Colonoscopy’, Journal of Clinical Gastroenterology, 53(8), pp. e316–e321. doi: 10.1097/MCG.0000000000001093.
García-García, E. M. et al. (2019) ‘Sociodemographic factors affecting the comprehension of clinical information by inpatients undergoing trauma surgery’, Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 63(5), pp. 355–360. doi: 10.1016/j.recote.2019.04.005.
Hall, D. E. et al. (2012) ‘Informed consent for inguinal herniorrhaphy and cholecystectomy: Describing how patients make decisions to have surgery’, American Journal of Surgery, 204(5), pp. 619–625. doi: 10.1016/j.amjsurg.2012.07.020.
Herfiyanti, L. (2015) ‘Kelengkapan Informed Consent Tindakan Bedah Menunjang Akreditasi Jci Standar Hpk 6 Pasien Orthopedi’, Jurnal Manajemen Informasi Kesehatan Indonesia, 3(2), pp. 81–88. doi: 10.33560/.v3i2.89.
Khan, R. I. (2012) ‘Patient Safety and the Importance of Informed Consent’, in Urolithiasis: Basic Science and Clinical Practice. Springer, London, pp. 543–546. doi: 10.1007/978-1-4471-4387-1_68.
Khoshrang, H. et al. (2021) ‘Research Paper: The Quality of Informed Consent Obtaining Before Electroconvulsive Therapy: A Report From a Referral, Academic Hospital’, Caspian Journal of Neurological Sciences, 7(1), pp. 37–41. doi: 10.32598/CJNS.7.24.6.
Kinman, C. L. et al. (2018) ‘Use of an iPadTM application in preoperative counseling for pelvic reconstructive surgery: a randomized trial’, International Urogynecology Journal, 29(9), pp. 1289–1295. doi: 10.1007/s00192-017-3513-2.
Koong, J. K. et al. (2021) ‘The effectiveness of handout assisted versus verbal consent on post-operative recall and understanding - A randomized control study’, Surgeon, (xxxx), pp. 1–8. doi: 10.1016/j.surge.2021.04.002.
Lemmu, B. et al. (2020) ‘Knowledge and Perception of Ethiopian Surgical Patients to Informed Consent Practice for Surgical Procedures’, Open Access Surgery, 13, pp. 65–70. doi: http://dx.doi.org/10.2147/OAS.S268009.
Li Ching Ng, A. et al. (2021) ‘Consent for spine surgery: an observational study’, ANZ Journal of Surgery, pp. 1220–1225. doi: 10.1111/ans.16348.
Lin, Y. K. et al. (2017) ‘Development and pilot testing of an informed consent video for patients with limb trauma prior to debridement surgery using a modified Delphi technique’, BMC Medical Ethics, 18(1), pp. 1–12. doi: 10.1186/s12910-017-0228-3.
Lin, Y. K. et al. (2019) ‘How to effectively obtain informed consent in trauma patients: A systematic review’, BMC Medical Ethics, 20(1). doi: 10.1186/s12910-019-0347-0.
Marcus, H. J. et al. (2018) ‘Informed Consent for Patients Undergoing Transsphenoidal Excision of Pituitary Adenoma: Development and Evaluation of a Procedure-Specific Online Educational Resource’, World Neurosurgery, 118, pp. e933–e937. doi: 10.1016/j.wneu.2018.07.102.
Moeini, S., Shahriari, M. and Shamali, M. (2020) ‘Ethical challenges of obtaining informed consent from surgical patients’, Nursing Ethics, 27(2), pp. 527–536. doi: 10.1177/0969733019857781.
Mudiyanselage, U. et al. (2019) ‘Are predominantly western standards and expectations of informed consent in surgery applicable to all ? A qualitative study in a tertiary care hospital in Sri Lanka’. doi: 10.1136/bmjopen-2018-025299.
Nnabugwu, I. I. et al. (2017) ‘Informed consent for clinical treatment in low-income setting: Evaluating the relationship between satisfying consent and extent of recall of consent information’, BMC Medical Ethics, 18(1), pp. 1–8. doi: 10.1186/s12910-017-0227-4.
Nuraeni, Ri. (2016) ‘Relationship of surgical procedure knowledge with level anxiety of adult surgical patients in the surgical room of cideres hospital period of May-June 2015’, Journal of nursing and health, II.
Overcarsh, P., Arvizo, C. and Harvey, L. (2019) ‘Informed consent in gynecologi surgery’, Current Opinion in Obstetrics and Gynecology, 31(4), pp. 240–244. doi: 10.1097/GCO.0000000000000550.
Pallett, A. C. et al. (2018) ‘A randomized controlled trial to determine whether a video presentation improves informed consent for hysterectomy’, American Journal of Obstetrics and Gynecology, 219(3), pp. 277.e1-277.e7. doi: 10.1016/j.ajog.2018.06.016.
Paterick, Z. R., Paterick, T. E. and Paterick, B. B. (2020) ‘Medical informed choice: Understanding the element of time to meet the standard of care for valid informed consent’, Postgraduate Medical Journal, 96(1141), pp. 708–710. doi: 10.1136/postgradmedj-2019-137278.
Perin, A. et al. (2021) ‘Informed consent through 3D virtual reality: a randomized clinical trial’, Acta Neurochirurgica, 163(2), pp. 301–308. doi: 10.1007/s00701-020-04303-y.
Pucher, P. H. et al. (2019) ‘Informing the Consent Process for Surgeons: A Survey Study of Patient Preferences, Perceptions, and Risk Tolerance’, Journal of Surgical Research, 235(0), pp. 298–302. doi: 10.1016/j.jss.2018.09.046.
Richardson, V. (2013) ‘Patient comprehension of informed consent.’, Journal of perioperative practice, 23(1–2), pp. 26–30. doi: 10.1177/1750458913023001-204.
Rouf, C. E. et al. (2017) ‘Impact of a multimedia support on the understanding of medical information by hearing-impaired patients before cochlear implantation’, European Annals of Otorhinolaryngology, Head and Neck Diseases, 134(6), pp. 387–392. doi: 10.1016/j.anorl.2017.05.001.
Ruiz López, P. (2013) ‘Informed Consent in Surgery. Distance Between Theory and Practice’, Cirugía Española (English Edition), 91(9), pp. 551–553. doi: 10.1016/j.cireng.2013.12.015.
Ruske, J. et al. (2021) ‘Patient comprehension necessary for informed consent for vascular procedures is poor and related to frailty’, Journal of Vascular Surgery, 73(4), pp. 1422–1428. doi: 10.1016/j.jvs.2020.06.131.
Sceats, L. A. et al. (2019) ‘Lost in translation: Informed consent in the medical mission setting’, Surgery (United States), 165(2), pp. 438–443. doi: 10.1016/j.surg.2018.06.010.
Shemesh, S. et al. (2019) ‘The_quality_of_informed_consent_obtained_for_ortho.pdf’, Journal ofOrthopaedic Surgery 27(2), 27(2), pp. 1–8.
Singh, A., Rochwani, R. and Oberoi, S. (2021) ‘Informed consent and responses of surgical patients: A study in North India’, National Journal of Physiology, Pharmacy and Pharmacology, 11(8), p. 1. doi: 10.5455/njppp.2021.11.06217202109072021.
Stewart, J. A. et al. (2021) ‘Visual teaching aids improve patient understanding and reduce anxiety prior to a colectomy’, American Journal of Surgery, 222(4), pp. 780–785. doi: 10.1016/j.amjsurg.2021.01.029.
Susanto, D. P., Pratama, B. S. and Hariyanto, T. (2017) ‘Analysis of Factors Affecting Patient Understanding of Informed Consent in Hospitals’, Indonesian Journal of Health Management, 5(2), pp. 73–81. doi: 10.14710/jmki.5.2.2017.73-81.
Tricco, A. C. et al. (2018) ‘PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation’, Annals of Internal Medicine, 169(7), pp. 467–473. doi: 10.7326/M18-0850.
Ulfa, H. M. (2018) ‘Analisa Kelengkapan Informed Consent Tindakan Operasi di Rumah Sakit Sansani Pekanbaru’, Jurnal INOHIM, 6(1), pp. 21–26. Available at: https://inohim.esaunggul.ac.id/index.php/INO/article/download/145/125.
Villanueva, C., Talwar, A. and Doyle, M. (2018) ‘Improving informed consent in cardiac surgery by enhancing preoperative education’, Patient Education and Counseling, 101(12), pp. 2047–2053. doi: 10.1016/j.pec.2018.06.008.
Weise, A. et al. (2021) ‘Development, piloting, and evaluation of an evidence-based informed consent form for total knee arthroplasty (EvAb-Pilot): a protocol for a mixed methods study’, Pilot and Feasibility Studies, 7(1), pp. 1–11. doi: 10.1186/s40814-021-00843-x.
Wiesen, B. M. et al. (2020) ‘Use of Surgical Risk Preoperative Assessment System (SURPAS) and Patient Satisfaction During Informed Consent for Surgery’, Journal of the American College of Surgeons, 230(6), pp. 1025-1033.e1. doi: 10.1016/j.jamcollsurg.2020.02.049.
Wong, A. L. et al. (2016) ‘The Effect of Written Information on Recall of Surgical Risks of Carpal Tunnel Release Surgery: A Randomized Controlled Study’, Plastic and Reconstructive Surgery, 138(6), pp. 1011e-1018e. doi: 10.1097/PRS.0000000000002771.
Yoon, S. H. et al. (2019) ‘Personalized 3D-Printed Model for Informed Consent for Stage I Lung Cancer: A Randomized Pilot Trial’, Seminars in Thoracic and Cardiovascular Surgery, 31(2), pp. 316–318. doi: 10.1053/j.semtcvs.2018.10.017.
Zimmermann, A. et al. (2021) ‘Written informed consent—translating into plain language. A pilot study’, Healthcare (Switzerland), 9(2). doi: 10.3390/healthcare9020232.