A randomized controlled trial to determine whether a video presentation improves informed consent for hysterectomy.

BACKGROUND: Informed consent is an integral part of the preoperative counseling process. It is important that we know the best way to relay this information to patients undergoing surgery, specifically, hysterectomy. OBJECTIVE: We sought to determine whether supplementing normal physician counseling with a video presentation improves patient comprehension during the informed consent process for hysterectomy. STUDY DESIGN: In a randomized, mixed factorial controlled trial, standard physician counseling (control arm) was compared to physician counseling plus video presentation (video arm) during the prehysterectomy informed consent process. Primary outcome was improvement in patient comprehension measured by assessments at baseline, postcounseling, day of surgery, and postsurgery. Patient satisfaction was measured by a validated questionnaire. Audiotaped patient-physician interactions were analyzed to determine time spent counseling, number of patient questions, and whether standard counseling included 11 predetermined critical components included in the video. A sample size of 60 per group (N = 120) was planned to compare both groups. RESULTS: From May 2014 through June 2015, 120 patients were enrolled and 116 randomized: 59 to the video arm and 57 to the control arm. All characteristics were similar between groups. Video arm subjects demonstrated greater improvement in comprehension scores in both postcounseling (9.9% improvement; 95% confidence interval, 4.2-15.7%; P = .0009) and day-of-surgery questionnaires (7.2% improvement; 95% confidence interval, 0.96-13.4%; P = .02). Scores 4-6 weeks after surgery returned to baseline for both groups. Control subjects were less likely to be counseled about risk of thrombosis (P < .0001), colostomy (P < .0001), further medical/surgical therapy (P = .002), hormone replacement therapy (P < .0001), or postoperative expectations (P < .0001). Physicians spent more time counseling patients who did not watch the video (8 vs 12 minutes, P = .003) but number of questions asked by patients in each group was similar. CONCLUSION: Enhancing prehysterectomy counseling with a video improves patient comprehension through day of surgery, increases thoroughness of counseling, and reduces physician time.

Experimental investigations of weak definite and weak indefinite noun phrases.

Definite noun phrases typically refer to entities that are uniquely identifiable in the speaker and addressee's common ground. Some definite noun phrases (e.g., the hospital in Mary had to go the hospital and John did too) seem to violate this uniqueness constraint. We report six experiments that were motivated by the hypothesis that these "weak definite" interpretations arise in "incorporated" constructions. Experiments 1-3 compared nouns that seem to allow for a weak definite interpretation (e.g., hospital, bank, bus, radio) with those that do not (e.g., farm, concert, car, book). Experiments 1 and 2 used an instruction-following task and picture-judgment task, respectively, to demonstrate that a weak definite need not uniquely refer. In Experiment 3 participants imagined scenarios described by sentences such as The Federal Express driver had to go to the hospital/farm. Scenarios following weak definite noun phrases were more likely to include conventional activities associated with the object, whereas following regular nouns, participants were more likely to imagine scenarios that included typical activities associated with the subject; similar effects were observed with weak indefinites. Experiment 4 found that object-related activities were reduced when the same subject and object were used with a verb that does not license weak definite interpretations. In Experiment 5, a science fiction story introduced an artificial lexicon for novel concepts. Novel nouns that shared conceptual properties with English weak definite nouns were more likely to allow weak reference in a judgment task. Experiment 6 demonstrated that familiarity for definite articles and anti-familiarity for indefinite articles applies to the activity associated with the noun, consistent with predictions made by the incorporation analysis.

"Some," and possibly all, scalar inferences are not delayed: Evidence for immediate pragmatic enrichment.

Scalar inferences are commonly generated when a speaker uses a weaker expression rather than a stronger alternative, e.g., John ate some of the apples implies that he did not eat them all. This article describes a visual-world study investigating how and when perceivers compute these inferences. Participants followed spoken instructions containing the scalar quantifier some directing them to interact with one of several referential targets (e.g., Click on the girl who has some of the balloons). Participants fixated on the target compatible with the implicated meaning of some and avoided a competitor compatible with the literal meaning prior to a disambiguating noun. Further, convergence on the target was as fast for some as for the non-scalar quantifiers none and all. These findings indicate that the scalar inference is computed immediately and is not delayed relative to the literal interpretation of some. It is argued that previous demonstrations that scalar inferences increase processing time are not necessarily due to delays in generating the inference itself, but rather arise because integrating the interpretation of the inference with relevant information in the context may require additional time. With sufficient contextual support, processing delays disappear.