| 1.
AUTHOR | Herz-D-A,
Looman-J-E, Lewis-S-K. |
| INSTITUTION | Division
of Neurosurgery, Michigan State University, Grand Rapids. |
| TITLE | Informed
consent: is it a myth? (see comments). |
| SOURCE | Neurosurgery
1992 Mar, VOL: 30 (3), P: 453-8, ISSN: 0148-396X. CM Comment in: Neurosurgery
1992 Aug; 31(2):380-1. |
| ABSTRACT | The
issue of informed consent at it relates to neurosurgical professional malpractice
liability and litigation has been of concern for 20 years or more. The problem
persists, and the subject has been addressed by providing patient education with
full disclosure regarding neurosurgical procedures. In the process of imparting
informed consent, the authors studied the effectiveness of specific neurosurgical
health care teaching. One hundred six persons undergoing anterior cervical fusion
or lumbar laminectomy were instructed by a neurosurgeon and clinical nurse specialist
with a master's degree in neurosurgery. Written testing was performed in each
case immediately after a formal teaching session before surgery. Questions were
simple and covered only four general topics: 1) diagnosis and surgical techniques;
2) operative risks; 3) postoperative care; and 4) goals and benefits relating
to surgery. The mean score on testing immediate retention of information revealed
a 43.5% overall performance rate. When patients were tested approximately 6 weeks
later, the score dropped to 38.4%. This was statistically significant (chi 2,
P less than 0.05). The authors encourage the concept of patient education. The
data in the current study, however, suggest that the reasonable and prudent neurosurgeon
making a concerted effort at patient education, with the assistance of a professional
educator, cannot necessarily expect accurate patient or family recall or comprehension.
Fulfillment of the doctrine of informed consent by neurosurgeons may very well
be mythical. Author. |
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| 2.
AUTHOR | Hekkenberg-R-J,
Irish-J-C, Rotstein-L-E, Brown-D-H, Gullane-P-J. |
| INSTITUTION | Department
of Otolaryngology, Toronto Hospital, University of Toronto, Ontario. |
| TITLE | Informed
consent in head and neck surgery: how much do patients actually remember? |
| SOURCE | J-Otolaryngol
1997 Jun, VOL: 26 (3), P: 155-9, ISSN: 0381-6605. |
| ABSTRACT | This
study was conducted to evaluate the effectiveness ofinformed consent in head and
neck surgery by testing patient recall of potential complications from thyroidectomy,
parathyroidectomy, and parotidectomy. DESIGN: A prospective design was
used. SETTING: The setting was an academic tertiary care centre. METHODS:
Fifty-four patients undergoing thyroidectomy, parathyroidectomy, or parotidectomy
were consented by verbal contact by the operating surgeon with a specific preoperative
checklist of complication and side effects. One week to 2 months after consent,
the patients were surveyed for recall of potential complications. MAIN OUTCOME
MEASURES: Rate of recall was related to various parameters including patient
age, sex, level of education, occupation, and length of time from the consent
interview to the recall interview. RESULTS: The overall recall rate for
all procedures was 48%. Those patients who recalled over 50% of the complications
were younger (p = .04) and better educated (p = .04). The gender of the patients
did not appear to influence recall success (p = 1.00), even when facial scar or
paralysis was considered. CONCLUSION: A significant relationship exists
between education level and patient age and the rate of patient recall of potential
complications of surgery. Author. |
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| 3.
AUTHOR | Yoshioka-H. |
| INSTITUTION | Department
of Orthopedic Surgery, Yodogawa Christian Hospital, Osaka, Japan. |
| TITLE | (Informed
consent in orthopedic surgery). |
| SOURCE | Nippon-Seikeigeka-Gakkai-Zasshi
1993 Jan, VOL: 67 (1), P: 40-8, ISSN: 0021-5325. |
| ABSTRACT | Twenty-eight
patients who had total joint replacement (TJR) and twenty-eight patients who sustained
open reduction for fracture within or close to the joint were studied to determine
their recall of the informed consent procedure. The questionnaire covered a postoperative
time range of more than 5 months and less than 6 years (average: 2 years and 4
months). The patient's recall and the doctor's document of informed consent were
scored 4 points for diagnosis and treatment, 1 point for prognosis, 3 points for
benefits, 4 points for complications and 1 point for alternatives with a total
of 13 points. In TJR, the average recall and document score were 8.6 points and
6.5 points respectively; and in fracture, 6.6 points and 4.9 points. Fifty-seven
per cent of the patients with TJR recalled the risk of infection; and 54 per cent
recalledthe problem of loosening. Twenty-nine per cent of the patients with fracture
recalled the risk of infection, and 29 per cent the risk of nonunion. In TJR,
the recall score was related to the patient's age and the document score. There
was significant difference in document scores among doctors. As a result of this
study, standard documents for informed consent in each operation have been compiled
with the aid of a word-processor to improve the quality of informed consent. Author. |
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| 4.
AUTHOR | Saw-K-C,
Wood-A-M, Murphy-K, Parry-J-R, Hartfall-W-G. |
| INSTITUTION | Department
of Urology, Ipswich Hospital, Suffolk, UK. |
| TITLE | Informed
consent: an evaluation of patients' understanding and opinion (with respect to
the operation of transurethral resection of prostate). |
| SOURCE | J-R-Soc-Med
1994 Mar, VOL: 87 (3), P: 143-4, ISSN: 0141-0768. |
| ABSTRACT | The
ability of patients to understand and recall information given prior to obtaining
written consent was assessed in 55 patients who were due to undergo the operation
of transurethral resection of prostate. The patients were also asked their opinion
on informed consent. Most patients knew the position of the prostate and the purpose
of the operation. Some aspects of the postoperative management and complications
were less well remembered. In particular, 18% of the patients could not remember
the possibility of retrograde ejaculation despite efforts to emphasize this. Of
the patients who returned their questionnaires, 41% did not mind what happened
to them provided they were made better; 54% trusted their doctor to do the right
thing and did not think detailed explanation was important; 62% felt that consent
forms are to protect the doctor's right; still most patients felt that consent
forms were necessary. Sub-groups comparison showed no relationship between patients'
attitude and their ability to recall information. Author. |
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| 5.
AUTHOR | Cassileth-B-R,
Zupkis-R-V, Sutton-Smith-K, March-V. |
| INSTITUTION | University
of Pennsylvania Cancer Center, Philadelphia. |
| TITLE | Informed
consent -- why are its goals imperfectly realized? |
| SOURCE | N-Engl-J-Med
1980 Apr 17, VOL: 302 (16), P: 896-900, ISSN: 0028-4793. |
| ABSTRACT | We
explored reasons for the failure of patients to recall major portions of the information
on consent forms and in oral explanations about consent. Within one day of signing
consent forms for chemotherapy, radiation therapy, or surgery, 200 cancer patients
completed a test of their recall of the material in the consent explanation and
filled out a questionnaire regarding their opinions of its purpose, content, and
implications. Only 60 per cent understood the purpose and nature of the procedure,
and only 55 per cent correctly listed even one major risk or complication. We
found that three factors were related to inadequate recall: education, medical
status, and the care with which patients thought they had read their consent forms
before signing. Only 40 per cent of the patients had read the form "carefully."
Most believed that consent forms were meant to "protect the physician's rights."
Although most thought that consent forms were necessary and comprehensible and
that they contained worthwhile information, the legalistic connotations of the
forms appeared to lead to cursory reading and inadequate recall. Author. |
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| 6.
AUTHOR | Hutson-M-M,
Blaha-J-D. |
| INSTITUTION | Section
of Arthritis Surgery, West Virginia University, Morgantown 26506. |
| TITLE | Patients'
recall of preoperative instruction for informed consent for an operation (see
comments). |
| SOURCE | J-Bone-Joint-Surg
(Am) 1991 Feb, VOL: 73 (2), P: 160-2, ISSN: 0021-9355. CM Comment in: J-Bone-Joint-Surg-(Am)
1991 Feb; 73(2):159. |
| ABSTRACT | Thirty
eight consecutive patients who were admitted to the hospital for total joint replacement
were studied to determine their understanding of the elements of informed consent
at the time when they signed the consent document before the operation and their
recall of those elements six months after the operation. All patients received
instruction from the same patient educator before the operation. Each patient
was asked to respond verbally to a questionnaire about the preoperative instruction.
If a question was not answered correctly, tutoring was given until the patient
gave the correct response. The consent document was not presented for signature
until the patient could answer all questions correctly. In an interview six months
after the operation, thirty six of the thirty eight patients were asked the same
questions that they had answered before the operation. The recall of risks and
benefits six months after the operation was compared with the understanding of
risks and benefits that had been demonstrated before the operation by both the
verbal questioning and the signed consent document. At six months, the number
of patients who recalled the risks ranged from nine (25 per cent) who remembered
the risk of infection to only one who remembered the risk of damage to a nerve
or artery. More patients recalled the potential benefits:eight (22 per cent) for
relief of pain and improved function and five (16 per cent) for improved motion.
Author. |