Informing the consent process.

Because the legal and ethical aspects of informed consent are often foremost in clinicians’ minds, it is easy to forget that the purpose of informed consent is to aid in decision making. Informed consent forms, for example, are often written with legal and institutional priorities in mind,1 and patients in turn assume that the primary purpose of such forms is to protect physicians and their institutions.2 Indeed, it is understandable that clinicians may take little intrinsic interest in the informed consent process when seen as an external legal requirement. Article See p 21 What would happen if the informed consent process were truly seen as an opportunity for optimizing decision making? The traditional attempts at improving informed consent tend to focus only on patient outcomes, typically on whether their factual understanding or satisfaction improves. In this issue of Circulation: Cardiovascular Quality and Outcomes , Arnold and colleagues3 describe their initial experience using a Web-based individualized risk assessment tool (the Patient Refined Expectations for Deciding Invasive Cardiac Treatments [PREDICT]) as part of the informed consent process for percutaneous coronary intervention (PCI). The results of their study show that, in comparison with historical controls, patients undergoing the customized consent were in general much more involved (and perceived themselves to be so) in the consent process, and, interestingly, the customized consent seems to have affected the choice of stents used. These data …