Consent in forefoot surgery; What does it mean to the patient?

Autor: Baxendale-Smith LD; The University of Edinburgh Medical School, 47 Little France Crescent, Edinburgh EH16 4TJ, Scotland, United Kingdom. Electronic address: s1603644@ed.ac.uk., Middleton SD; Department of Orthopaedics - Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom., McKinley JC; Department of Orthopaedics - Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom., Thomson CE; Department of Orthopaedics - Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom.
Jazyk: angličtina
Zdroj: Foot (Edinburgh, Scotland) [Foot (Edinb)] 2020 Dec; Vol. 45, pp. 101741. Date of Electronic Publication: 2020 Sep 25.
DOI: 10.1016/j.foot.2020.101741
Abstrakt: Aims: This study aimed to assess patient risk recall and find risk thresholds for patients undergoing elective forefoot procedures.
Methods: Patients were interviewed in the pre-assessment clinic (PAC) or on day of surgery (DOS); some in both settings. A standardised questionnaire was used for all interviews, regardless of setting. Patients were tested on which risks they recalled from their consent process, asked for thresholds for five pre-chosen risks and asked about a sham risk.
Results: Across all interviews, risk recall on DOS (2.34 risks/patient interview) was significantly lower (p=.05) than in PAC (2.95 risks/patient interview) - this was repeated when comparing results from patients interviewed in both settings only with PAC mean recall of 2.93 risks/patient interview and DOS mean recall of 2.57 risks/patient interview. The mean reported risk thresholds greatly exceeded NHS Lothian's observed complication rates for forefoot procedures. The five risks tested for thresholds produced the same order in each interview setting, suggesting a patient-perceived severity ranking. Patients answering the sham risk question incorrectly tended to recall fewer risks across all interviews.
Conclusions: This study shows that patient risk recall is poor, as previous literature outlines, reinforcing that consent process improvements could be made. It also illustrates the value of PAC visits in patient education, as shown by higher levels of recall when compared to DOS.
(Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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