Explanatory language in dental informed consent communication

Anastasiia  Pysarenko; Viktoriia  Kostenko

doi:10.32345/USMYJ.4(158).2025.172-183

Anastasiia Pysarenko Master Student, Poltava State Medical University, Poltava, Ukraine
Viktoriia Kostenko Associate Professor, Сandidate of Philological Sciences, Department of Foreign Languages, Latin and Medical Terminology, Poltava State Medical University, Poltava, Ukraine https://orcid.org/0000-0001-9077-2191

DOI: https://doi.org/10.32345/USMYJ.4(158).2025.172-183

Keywords: Dental Care, Health Communication, Informed Consent, Patient-Centered Care, Patient Education, Terminology.

Abstract

Informed consent is a legal and ethical cornerstone of dental care, yet its effectiveness depends not only on content but also on clarity of communication. While existing research extensively covers the ethical and legal aspects, less attention has been given to the linguistic strategies that shape patient comprehension. This study examines the use of code glosses, i.e. in-text clarifications of technical terms, in 50 informed consent forms (ICFs) used in U.S. dental practices. Using Hyland’s metadiscourse model and the Text Inspector tool, glosses were identified, categorized, and analyzed across different sections of the forms. Results show that Explanation glosses dominate (45.9%), with Implication and Exemplification glosses each at 19.7%. Most glosses appear in Procedure (30%) and Diagnosis (28%) sections, while fewer are found in Risk (22%) and Consent statements (10%). These findings highlight areas where patients may receive insufficient support to understand complex or abstract information, particularly when it comes to making truly informed choices. Glosses improve readability by unpacking specialized language and reducing cognitive load, especially under conditions of stress or limited health literacy. Despite their benefits, certain gloss types, such as analogies or conditionally phrased advisories, remain underused, possibly due to legal caution or a preference for standardized phrasing. The study underscores that code glosses are essential communicative tools, not mere stylistic additions. Greater integration of patient-friendly language and multimodal strategies is recommended to strengthen informed consent practices and promote clearer, more equitable healthcare communication.

References

Grzybowski A, Patryn R, Sak J, Zagaja A. Informed consent in COVID-19 research: An ethical analysis of clinical studies performed during the pandemic. Medicina (Kaunas). 2023;59(7):1234. doi:10.3390/medicina59071234

Grady C. Enduring and emerging challenges of informed consent. N Engl J Med. 2015;372(9):855-62. doi:10.1056/NEJMra1411250

Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283(20):2701-11. doi:10.1001/jama.283.20.2701

Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 8th ed. New York: Oxford University Press; 2019. 512 p.

Faden RR, Beauchamp TL. A History and Theory of Informed Consent. New York: Oxford University Press; 1986. 408 p.

Manson NC, O’Neill O. Rethinking Informed Consent in Bioethics. Cambridge: Cambridge University Press; 2007. 212 p.

Judkins-Cohn TM, Kielwasser-Withrow K, Owen M, Ward J. Ethical principles of informed consent: Exploring nurses’ dual role of care provider and researcher. J Contin Educ Nurs. 2014;45(1):35-42. doi:10.3928/00220124-20131223-03

Berlan ED, Bravender T. Confidentiality, consent, and caring for the adolescent patient. Curr Opin Pediatr. 2009;21(4):450-6. doi:10.1097/MOP.0b013e32832ce009

Chung RJ, Lee JB, Hackell JM, Alderman EM; Committee on Adolescence; Committee on Practice & Ambulatory Medicine. Confidentiality in the care of adolescents: Technical report. Pediatrics. 2024;153(5):e2024066326. doi:10.1542/peds.2024-066326

Joffe S, Miller FG. Bench to bedside: Mapping the moral terrain of clinical research. Hastings Cent Rep. 2008;38(2):30-42. doi:10.1353/hcr.2008.0019

Sugarman J, Califf RM. Ethics and regulatory complexities for pragmatic clinical trials. JAMA. 2014;311(23):2381-2. doi:10.1001/jama.2014.4164

Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283(20):2701-11. doi:10.1001/jama.283.20.2701

Corrigan O. Empty ethics: The problem with informed consent. Sociol Health Illn. 2003;25(7):768-92. doi:10.1111/1467-9566.00386

Sariola S, Simpson B. Theorising the ‘human subject’ in biomedical research: International clinical trials and bioethics discourses in contemporary Sri Lanka. Soc Sci Med. 2011;73(4):515-22. doi:10.1016/j.socscimed.2010.11.024

Tan J, Passerini G, Stewart A. Consent and confidentiality in clinical work with young people. Clin Child Psychol Psychiatry. 2007;12:191-210. doi:10.1177/1359104507075921

Grady C. Enduring and emerging challenges of informed consent. N Engl J Med. 2015;372(9):855-62. doi:10.1056/NEJMra1411250

Appelbaum PS, Lidz CW, Meisel A. Informed Consent: Legal Theory and Clinical Practice. 2nd ed. New York: Oxford University Press; 2001.

Appelbaum PS, Lidz CW, Meisel AM. Informed consent: Legal theory and clinical practice. New York: Oxford University Press; 1987. 314 p.

Villafranca A, Kereliuk S, Hamlin C, Johnson A, Jacobsohn E. The appropriateness of language found in research consent form templates: A computational linguistic analysis. PLoS One. 2017;12(2):e0169143. doi:10.1371/journal.pone.0169143

Kazembe DM, Woldeamanuel Y, Abay SM. Researchers’ experience and views on participants’ comprehension of informed consent in clinical trials in Malawi: A descriptive qualitative study. BMC Med Ethics. 2024;25(1):101. doi:10.1186/s12910-024-01100-5

Santel F, Bah I, Kim K, McCracken J, Teme A. Assessing readability and comprehension of informed consent materials for medical device research: A survey of informed consents from FDA’s Center for Devices and Radiological Health. Contemp Clin Trials. 2019;85:105831. doi:10.1016/j.cct.2019.105831

AlDehlawi H, Jazzar A, Al-Turki G, Alhamed S, Akeel S, Mullah Y, Alshakweer F, Farag AM. Enhancing communication in dental clinics through understanding oral medicine terminology. Open Dent J [Internet]. 2023;18:e18742106302370. Available from: https://www.opendentistryjournal.com/VOLUME/18/ELOCATOR/e18742106302370/FULLTEXT/

Goldschmitt M, Gleim P, Mandelartz S, Kellmeyer P, Rigotti T. Digitalizing informed consent in healthcare: A scoping review. BMC Health Serv Res. 2025;25(1):893. doi:10.1186/s12913-025-12964-7

Kostenko VH, Bieliaieva OM, Solohor IM. Is the language of informed consent templates for dental treatment patient-friendly? 11th ECLSS Conf Lang Soc Sci. 2021:77-8.

Reid KI. Informed consent in dentistry. J Law Med Ethics. 2017;45(1):77-94. doi:10.1177/1073110517703102

Barkovska A, Kostenko V. The state of patient-dentist communication among the adult population of Ukraine. USMYJ. 2023;141(3):7-13. Available from: https://mmj.nmuofficial.com/index.php/journal/article/view/352

Bala S, Keniston A, Burden M. Patient perception of plain-language medical notes generated using artificial intelligence software: Pilot mixed-methods study. JMIR Form Res. 2020;4(6):e16670. doi:10.2196/16670

Feldman-Stewart D, Brennenstuhl S, McIssac K, Austoker J, Wilson BJ. A systematic review of information in decision aids. Health Expect. 2013;16(4):297-309. doi:10.1111/j.1369-7625.2011.00740.x

Grady C, Cummings SR, Rowbotham MC, McConnell MV, Ashley EA, Kang G. Informed consent. N Engl J Med. 2017;376(9):856-67. doi:10.1056/NEJMra1603773

Paasche-Orlow MK, Taylor HA, Brancati FL. Readability standards for informed-consent forms as compared with actual readability. N Engl J Med. 2003;348(8):721-6. doi:10.1056/NEJMsa021212

Kass NE, Faden RR. Informed consent: Does it really matter? J Clin Invest. 2018;128(9):3847-50. doi:10.1172/JCI122556

Bester J, Cole CM, Kodish E. The limits of informed consent for an overwhelmed patient: Clinicians’ role in protecting patients and preventing overwhelm. AMA J Ethics. 2016;18(9):869-86. doi:10.1001/journalofethics.2016.18.9.peer2-1609

Shah P, Thornton I, Kopitnik NL, Venkatesh S. Informed consent. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430827/

Agozzino E, Borrelli S, Cancellieri M, Carfora FM, Di Lorenzo T, Attena F. Does written informed consent adequately inform surgical patients? A cross-sectional study. BMC Med Ethics. 2019;20(1):1. doi:10.1186/s12910-018-0340-z

Legg AM, Andrews SE, Huynh H, Ghane A, Tabuenca A, Sweeny K. Patients’ anxiety and hope: Predictors and adherence intentions in an acute care context. Health Expect. 2015;18(6):3034-43. doi:10.1111/hex.12288

Hyland K. Metadiscourse. London: Continuum; 2005.

Aguilar M, Arnó E. Metadiscourse in lecture comprehension: Does it really help foreign language learners? Atlantis. 2002;14:7-21.

Cao F, Hu G. Interactive metadiscourse in research articles: A comparative study of paradigmatic and disciplinary influences. J Pragmat. 2014;66:15-31. doi:10.1016/j.pragma.2014.02.007

Hyland K, Wang W, Jiang FK. Metadiscourse across languages and genres: An overview. Lingua. 2022;265:103205. doi:10.1016/j.lingua.2021.103205

Hyland K, Jiang FK. In this paper we suggest: Changing patterns of disciplinary metadiscourse. Engl Specif Purp. 2018;51:18-30. doi:10.1016/j.esp.2018.02.001

Hyland K. Applying a gloss: Exemplifying and reformulating in academic discourse. Appl Linguist. 2007;28(2):266-85. doi:10.1093/applin/amm011

World Health Organization. Principle: Understandable – use plain language [Internet]. Geneva: WHO; 2022. Available from: https://www.who.int/about/communications/understandable/plain-language

Palmer BW, Lanouette NM, Jeste DV. Effectiveness of multimedia aids to enhance comprehension of research consent information: A systematic review. IRB. 2012;34(6):1-15.

Galmarini E, Marciano L, Schulz PJ. The effectiveness of visual-based interventions on health literacy in health care: A systematic review and meta-analysis. BMC Health Serv Res. 2024;24(1):718. doi:10.1186/s12913-024-11138-1

Isaacs T, Murdoch J, Demjén Z, Stevenson F. Examining the language demands of informed consent documents in patient recruitment to cancer trials using tools from corpus and computational linguistics. Health. 2020;26(4):431-56. doi:10.1177/1363459320963431

Bax S, Waller D, Nakatsuhara F. Researching L2 writers’ use of metadiscourse markers at intermediate and advanced levels. System. 2019;83:79-95. doi:10.1016/j.system.2019.02.010

Voogt SJ, Pratt K, Rollet A. Patient communication: Practical strategies for better interactions. Fam Pract Manag. 2022;29(2):12-6. PMID:35290008

Chevalier BAM, Watson BM, Barras MA, Cottrell WN, Angus DJ. Using Discursis to enhance the qualitative analysis of hospital pharmacist-patient interactions. PLoS One. 2018;13(5):e0197288. doi:10.1371/journal.pone.0197288

Schiffrin D. In other words: Variation in reference and narrative. Cambridge: Cambridge University Press; 2006. 373 p.

Fage-Butler AM, Nisbeth Jensen M. Medical terminology in online patient–patient communication: Evidence of high health literacy? Health Expect. 2016;19(3):643-53. doi:10.1111/hex.12382

Castro CM, Wilson C, Wang F, Schillinger D. Babel babble: Physicians’ use of unclarified medical jargon with patients. Am J Health Behav. 2007;31 Suppl 1:S85-95. doi:10.5555/ajhb.2007.31.supp.S85

World Health Organization. Communicating risk in public health emergencies: A WHO guideline for emergency risk communication (ERC) policy and practice [Internet]. Geneva: WHO; 2017. Available from: https://www.ncbi.nlm.nih.gov/books/NBK540733/

Spence P, Westerman D, Rice R. Exemplification theory in health and risk messaging. Oxford Research Encyclopedia of Communication [Internet]. 2017 May 24 [cited 2025 Sep 10]. Available from: https://oxfordre.com/communication/view/10.1093/acrefore/9780190228613.001.0001/acrefore-9780190228613-e-526

Kinnersley P, Phillips K, Savage K, Kelly MJ, Farrell E, Morgan B, Butler CC. Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures. Cochrane Database Syst Rev. 2013;(7):CD009445. doi:10.1002/14651858.CD009445.pub2

Habiba M. Examining consent within the patient–doctor relationship. J Med Ethics. 2000;26(3):183-7. doi:10.1136/jme.26.3.183

Solomon ED, Mozersky J, Wroblewski MP, Baldwin K, Parsons MV, Goodman M, DuBois JM. Understanding the use of optimal formatting and plain language when presenting key information in clinical trials. J Empir Res Hum Res Ethics. 2022;17(1-2):177-92. doi:10.1177/15562646211037546

Stableford S, Mettger W. Plain language: A strategic response to the health literacy challenge. J Public Health Policy. 2007;28(1):71-93. doi:10.1057/palgrave.jphp.3200102

Giannouris P, Myridis T, Passali T, Tsoumakas G. Plain language summarization of clinical trials. In: Proceedings of the Workshop on DeTermIt! Evaluating Text Difficulty in a Multilingual Context @ LREC-COLING; 2024 May 21; Torino, Italy. Paris: ELRA/ISCA; 2024. p. 60-7.

Illustration material

Bone graft extraction consent. URL: https://mydentalday.com/wp-content/uploads/2018/12/bone-graft-extraction-consent.pdf

Informed Consent for Root Canal Treatment. URL: https://willowdental.com/wp-content/uploads/2021/04/ Informed-Consent-for-Endodontic-Treatment.pdf

Local anesthesia (injection) with oral premedication (pills before treatment). Informed consent and permission form – extractions. URL: https://mydentalday.com/wp-content/uploads/2018/12/consent_extraction.pdf .

Informed Consent for Recementation of Crowns and/or Bridges. URL: https://mydentalday.com/wp-content/uploads/2020/07/Informed-Consent-recementation-of-crown-and-or-bridges.pdf .

Informed Consent for Bone Grafting Procedures. URL: https://absolutdent.com/wp-content/uploads/2022/10/Informed_Consent_for_Bone_Grafting_Procedures.pdf

Informed consent for sealants. https://mydentalday.com/wp-content/uploads/2018/12/consent_sealants.pdf

Informed consent for removable prosthdontics - dentures (full, partial, immediate). URL: https://www.adc4smiles.com/assets/docs/informedconsentremoval.pdf