[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Medical ethics](https://durgical.com/en/medical-ethics/) › [Autonomy and consent](https://durgical.com/en/medical-ethics/areas/autonomy/) › Understanding in consent: framing, false beliefs and how to check

# Understanding in consent: framing, false beliefs and how to check

- Topic

Informing is not enough: the patient must understand. Numbers, framing and false beliefs change what they grasp and decide.

Updated Nov 13, 2026

## Key points

- Understanding means grasping what matters for the decision, not knowing every technical detail.
- Framing changes decisions: «90 % survive» and «10 % die» say the same thing and push in different directions.
- Relative risk inflates the impression; also give the absolute risk with the same numerical base.
- False belief: the patient understands the fact but, through a clear error, believes it does not apply to them; it is addressed before accepting the decision.
- Hope or a different value is not a false belief.
- Teach-back: ask the patient to explain in their own words what they understood.

## What it is

Consent is valid when the person grasps what matters for the decision: what is proposed, what they may gain, what they may lose and what other options exist. Many things get in the way: health literacy, numbers, language, pain, fear and haste. The way data are presented also changes the choice: in a classic 1982 study, the same surgery was chosen more often when described in terms of survival than of mortality, even by doctors. Another problem is false belief: the patient hears the fact but, through a clear error, believes it does not apply to them. That is different from hope or from holding different values. This page goes deeper into understanding, one of the elements of informed consent.

## Key facts

- Barriers: low health literacy, difficulty with numbers, language, pain, fear, sedation and haste.
- Framing effect: the same information presented as a gain or as a loss changes the choice (McNeil and colleagues, 1982).
- Frequencies («out of 100 people like you, 3...») are understood better than percentages and conditional probabilities.
- Denial: emotional rejection of the diagnosis; it is usually temporary and is met with time, not more data.
- Therapeutic misconception: in research, believing the study is designed for one's personal benefit.
- Long signed forms do not guarantee understanding and can make it worse.

## Step by step

- Ask what the patient already knows and what worries them.
- Explain in short chunks, without jargon, with absolute figures on the same base.
- Present the fact in both frames: how many benefit and how many do not.
- Ask the patient to explain in their own words what will be done, the main risk and the alternatives.
- Correct errors, ask again, and record how you checked understanding.

## In clinical practice

- Present «10 % die in surgery» together with «90 % survive», so as not to tilt the decision unintentionally.
- A treatment that «halves the risk» may lower it from 2 to 1 in 100 people; give both figures.
- A patient refuses a biopsy believing that «cutting the tumour spreads it»: this is a correctable belief; explain and offer another conversation.
- Use a professional interpreter when there is a language barrier; a relative who translates tends to filter and summarize.

## Legal framework in Colombia

- Ley 1751 de 2015, art. 10 d): «clear, appropriate and sufficient» information that allows free, conscious and informed decisions: the goal is that the patient can decide, not just that they were told.
- Ley 23 de 1981, art. 15: explain to the patient or those responsible for them, in advance, the consequences of treatments.
- Decreto 3380 de 1981, art. 12: record in the medical record that the foreseen risk was disclosed or that disclosure was not possible.
- Official texts checked on 2026-11-13 at minsalud.gov.co and normograma.supersalud.gov.co.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the framing effect in consent?

The same information, presented as a gain (survival) or as a loss (mortality), leads to different choices.

## Why give the absolute risk as well as the relative risk?

Because relative risk inflates the impression of benefit; halving a risk may mean going from 2 to 1 in 100 people.

## How does a false belief differ from hope?

A false belief denies a fact through a clear error (thinking the risk does not apply); hope accepts the fact and trusts in the best possible outcome.

## What is the teach-back method?

Asking the patient to explain in their own words what they understood, so errors can be corrected before they decide.

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## Elsewhere in DurgiPedia

- [Communication skills: open questions, empathy and teach-back](https://durgical.com/en/behavioral-science/communication-skills-open-questions-empathy-and-teach-back/)
- [Absolute risk reduction](https://durgical.com/en/epidemiology/absolute-risk-reduction/)
- [Relative risk reduction](https://durgical.com/en/epidemiology/relative-risk-reduction/)

## Connections

## Related 5

- [Informed consent: elements and how to obtain it](https://durgical.com/en/medical-ethics/informed-consent-elements-and-how-to-obtain-it/)
- [Standards of disclosure: what must the patient be told?](https://durgical.com/en/medical-ethics/standards-of-disclosure-what-must-the-patient-be-told/)
- [Decision-making capacity (competence) and how to assess it](https://durgical.com/en/medical-ethics/decision-making-capacity-and-how-to-assess-it/)
- [Informed consent in research](https://durgical.com/en/medical-ethics/informed-consent-in-research/)
- [Voluntariness: coercion, persuasion and manipulation](https://durgical.com/en/medical-ethics/voluntariness-coercion-persuasion-and-manipulation/)

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Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.

Sources: [Informed Consent](https://plato.stanford.edu/entries/informed-consent/) (Stanford Encyclopedia of Philosophy, 2025); [On the elicitation of preferences for alternative therapies (N Engl J Med 1982;306:1259-62)](https://pubmed.ncbi.nlm.nih.gov/7070445/) (PubMed, National Library of Medicine, 1982); [Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud](https://normograma.supersalud.gov.co/compilacion/docs/ley_1751_2015.htm) (Superintendencia Nacional de Salud, Normograma, 2015); [Ley 23 de 1981, por la cual se dictan normas en materia de ética médica](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/IGUB/ley-23-de-1981.pdf) (Ministerio de Salud y Protección Social, 1981); [Decreto 3380 de 1981, por el cual se reglamenta la Ley 23 de 1981](https://normograma.supersalud.gov.co/compilacion/docs/decreto_3380_1981.htm) (Superintendencia Nacional de Salud, Normograma, 1981).

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Source: https://durgical.com/en/medical-ethics/understanding-in-consent-framing-false-beliefs-and-how-to-check/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/understanding-in-consent-framing-false-beliefs-and-how-to-check/