Before any procedure, the patient and surgeon undergo an informed consent discussion of risks, benefits, alternatives, and procedural steps. By signing the consent, patients’ understanding is assumed. Unfortunately, many studies have shown the opposite, with patients lacking reasonable understanding of procedural knowledge, risks, and alternatives.^1-5

The teach-back method is a highly effective technique to reinforce understanding where physicians ask patients to repeat back information in their own words. If a patient is unclear on concepts, the physician can reeducate and improve understanding. It has been shown to improve patient education and satisfaction.³ Previous studies utilized one-on-one teach-back phone interviews to assess understanding;^4,5 however, few have examined this concept in urology. Our study aimed to evaluate preoperative patient understanding of various urological procedures using a teach-back–based phone interview.

We conducted one-on-one pre-
procedural phone interviews within a week prior to a patient’s procedure, where they were asked to recall general procedural knowledge and procedure-specific risks, benefits, and alternatives. A scoring system stratified patients into one of 3 understanding categories: incomplete (<25%), partial (25%–75%), and complete (>75%). If understanding was incomplete or partial, further education was provided.

The cohort (99) was 46% women and 32% Spanish speaking; 61% had a high school education or less, and the average±SD age was 64±10.9 years. Procedures included were intravesical botulinum toxin injection (24), mid urethral sling (9), colpocleisis (4), prostate biopsy (24), ureteroscopy (16), transurethral resection of the prostate (11), and transurethral resection of bladder tumor (11). The average percentage of risks identified was 12%, benefits 63%, and alternatives 35% (see Figure). Most patients correctly listed 1 benefit (92%) and 1 alternative (90%); however, only 65% could name 1 risk. About half (55%) correctly described their procedure and listed at least 1 risk, benefit, and alternative. No patients had complete understanding, but most had partial (74%). Patients had significantly higher understanding if they were female (p=0.02), underwent the same procedure previously (p <0.01) or any surgery within a year (p=0.02), and were undergoing in-office procedures (p=0.03). Following the interview, most patients (90%, 87) were satisfied with their understanding.

Our findings parallel similar studies with good recall of general knowledge, but poor recall of risks.^4,5 Although our study found a significant difference between understanding and sex, there was no association with age, education, language, and ethnicity. This contrasts with various literature revealing that patients with lower levels of education, socioeconomic status, health literacy, and older age have notably decreased preoperative understanding.^4,6,7 Patients who underwent prior surgeries or in-office procedures may be more familiar with the informed consent process and therefore have greater knowledge. In addition, we found teach-back interviews had substantial benefit in patient satisfaction (90%). In a comparable study with medical student-led preoperative interviews, patient self-perceived understanding did not correspond with the recall of risks; however, the interviews improved satisfaction (96%).⁶

Figure. The average percentage of risks, benefits, and alternatives reported by patients undergoing various urological procedures.

It is alarming that only 55% of patients could describe their procedure and list at least 1 risk, benefit, and alternative. Teach-back interviews hold promise in improving patient education prior to urological procedures by addressing knowledge gaps. Although patients may value different information in the decision-making process, the teach-back interview allows for additional education. Further studies on patient priorities and educational techniques could continue to improve patient understanding in urology.