Informed Consent in Orthodontics: CD-ROMs Promote Understanding in Medicaid Populations

Introduction: Language, education, socio-economic status, and past experience present barriers to obtaining informed consent (IC). This study assesses the effectiveness of a self-guided CD-ROM used to augment IC in a Medicaid population receiving interceptive orthodontic treatment.

Objective: Demonstrate effectiveness of CD-ROM in the understanding of orthodontic treatment by patients and parents.

Methods: Children were between dental ages 8-11 and eligible for Medicaid-funded orthodontic treatment in Washington. Children & their parents were randomized into either standard IC (SIC; n=33) or a CD-ROM plus standard IC (CDI; n=37). Both groups received IC by an orthodontic graduate student, but the CDI also viewed a CD-ROM with further information about orthodontic treatment, risks, procedures, and patient/parent responsibilities. The CD-ROM, produced in 4 languages, was a user-driven interactive video with a narrator and diverse child patients. Patients and parents were separately interviewed immediately following IC. Power calculations indicated 25 parent-patient pairs would provide sufficient power.

Results: CDI was more effective in communicating accurate information to both parents and patients about treatment. After viewing the CDI, children exhibited a trend towards better understanding treatment risks, and parents better understood the complicated risk of root resorption (p<0.05). CDI was particularly effective in relaying overall patient responsibilities to the children (p<0.01) and expected type of treatment to parents (p<0.05). CDI parents and patients had better knowledge of retainer needs (p<0.05).

Conclusions: A user-directed CD-ROM can be a useful adjunct to standard IC. Both children and parents are more accurately informed about risks, responsibilities, and treatment procedures following an interactive learning program.

Supported by NIDCR grant U54DE014254-02