An essential aspect of enabling patients to make autonomous decisions in a health care setting is that they must be in a favorable position to understand relevant information. Yet, there exists a lack of consensus on how the term understanding should be defined or assessed in this context, despite the fact that in practice clinicians regularly are required to judge whether patients have understood health information being conveyed. Current accounts of patient decision-making often focus on the information that needs to be disclosed to patients to support their autonomous decision-making. Far less attention has been afforded to questions about how to determine whether patients have understood the information that is disclosed to them. Theoretical approaches to the concept of understanding in this context, and practically useful frameworks for assessing it, are considered to be lacking. In a paper appearing in the October 2023 issue of the Journal of Evaluation in Clinical Practice, a number of hypothetical clinical situations are employed to explore the conditions that are required for a patient to understand information in medical decision-making adequately.
The author draws upon philosophical literature to examine how understanding might be defined and assessed in a medical context. Initially, the relationship between understanding and autonomy is outlined prior to using hypothetical clinical scenarios to explore which elements might be necessary for patient understanding. An argument is forwarded that an account of patient understanding must consider issues relating to the definition and operationalization of grasping, the requirement for factivity, and the concept of degrees of understanding. Finally, it is suggested how clinicians should assess understanding in practice. Drawing upon the wider philosophical literature, the following criteria are proposed that are necessary for understanding in a medical context: patients must (1) grasp a body of information that (2) reasonably reflects a responsible body of medical professionals' best estimate of the truth, (3) to a degree which meets a context-specific threshold. These criteria may prove to be beneficial in guiding assessments of patient understanding in clinical practice.