Meta-information |
Yes |
Partly |
No |
Comments |
Author of the information
– Institution or company is named.
– Authors are named.
If no authors are named:
– Scientific or medical advisers are named. |
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– |
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Topicality
– Date of issue is given. |
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– |
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Information sources
– Information sources are listed.
If yes:
– Allocation of the information sources is possible.
– Explanations of the information sources are provided (e.g., selection, evidence base, quality). |
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– |
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Objectives
– Any objective of the consent form is listed.
The objective listed is:
– Preparation for the pre-operation discussion.
– Support for a decision in favor of or against consenting to the procedure.
– Enabling the patient to make an informed decision.
– Documentation of the pre-operation discussion. |
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Signature
It is possible to document, that the patient
– consents to having the procedure,
– refuses to have the procedure,
– has received information,
– has read the consent form,
– has understood the information,
– waives their right to receiving the information,
– had enough time to consider their decision,
– pays attention to behavioral rules/is able to pay attention. |
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Contents
Explanations are given on:
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Yes |
Partly |
No |
Comments |
Type, extent, and undertaking of the intervention |
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– |
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Preparation and follow-up, including possible impairments/restrictions
(e.g., nil by mouth, fitness to drive, ability to work) |
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– |
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Further therapeutic/diagnostic measures,
that (may) result from the present intervention (e.g., reoperation) |
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– |
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Alternatives
– Option of doing nothing/watchful waiting.
– Additional treatment options. |
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– |
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Only for diagnostic procedures:
Test effectiveness
– Is described verbally.
– Numerical data (sensitivity, specificity, predictive values). |
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– |
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Benefit of the intervention regarding patient relevant endpoints
(mortality, morbidity, quality of life)
– Endpoints are named.
– Benefits are described in comparison with a different option.
– The probability of a benefit is quantified (verbally or numerically). |
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– |
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Harms/risks of the intervention regarding patient relevant endpoints
(mortality, morbidity, quality of life)
– Endpoints are named.
– Harms are described in comparison with a different option.
– The probability of harm is quantified (verbally or numerically). |
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– |
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How the information is presented |
Yes |
Partly |
No |
Comments |
Presentation of frequencies/rates of benefits and harms
– Frequencies/rates are presented by using verbal descriptors.
– Frequencies/rates are presented by using numerical descriptors.
(percentages or natural frequencies)
If numerical descriptors are used:
– The same reference values are used.
If benefits and/or harms are quantified in comparison with a control intervention
(numerical):
– Measures of relative risk are used.
– Measures of absolute risk are used. |
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– |
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Language
– Technical terms are used.
– Explanations are given for technical terms used.
– Directive language is used. |
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– |
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Supplementary materials
(films, 3D models, or multimedia modules)
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Yes |
Partly |
No |
Comments |
Films
– Are available.
– It is noted on the consent form whether the patient has received such material.
If supplementary materials are used, they include the following topics:
– Disease pattern.
– Processes.
– Risk communication. |
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