Anatomical Communication in Surgical Informed Consent Documents: An Exploratory Application of the Anatomical Clarity Framework

Why clinicians should know about it

• Picked for Anatomy (paper of the day, 31 July 2026): Anatomical clarity framework for consent documents

Abstract

Surgical informed consent documents represent an important interface between anatomical knowledge and patient-facing clinical information; however, no structured approach currently exists for evaluating how anatomy is represented and communicated within these materials. This study aimed to develop and apply an exploratory Anatomical Clarity Framework for evaluating anatomical communication in surgical informed consent documents. A cross-sectional document analysis was conducted on 10 General Surgery informed consent templates (five emergency and five elective/major procedures) obtained from a tertiary-care hospital in Türkiye. Readability was assessed using the Ateşman, Bezirci-Yılmaz, and Çetinkaya-Uzun indices. Document characteristics and anatomical communication features were evaluated using a structured assessment framework, and inter-rater agreement was examined using intraclass correlation coefficients. Anatomical information was present in all analyzed documents. Anatomical structures and procedural targets were generally identified; however, substantial variability was observed in explanatory features supporting anatomical communication, including anatomy-risk linkages, plain-language anatomical explanations, and visual representations. A recurring pattern across documents was the combination of high anatomical specificity with limited explanatory support and minimal visual representation. Only one document included a schematic anatomical illustration. All documents demonstrated high readability demands, corresponding to difficult, very difficult, or academic-level categories across the applied readability indices. Readability, document design, and anatomical communication described complementary rather than interchangeable characteristics of the analyzed documents. Communicative and anatomical domain scores appeared broadly similar across emergency and elective templates. The Anatomical Clarity Framework demonstrated good inter-rater agreement, with the strongest agreement observed in the Anatomical Clarity domain (intraclass correlation coefficient = 0.858). These findings suggest that the presence of anatomical information alone does not necessarily correspond to a high level of anatomical clarity. The Anatomical Clarity Framework provides a structured approach for evaluating how anatomical information is represented, contextualized, and communicated within surgical consent documents and may complement conventional readability assessments in clinical anatomy research. Because this study represents an initial methodological application of the framework, the findings should be interpreted as preliminary and require further validation in broader clinical settings.

Abstract as published, via PubMed.