TY - JOUR
T1 - Informed Consent and Informed Decision-Making in High-Risk Surgery
T2 - A Quantitative Analysis
AU - Long, Kristin L.
AU - Ingraham, Angela M.
AU - Wendt, Elizabeth M.
AU - Saucke, Megan C.
AU - Balentine, Courtney
AU - Orne, Jason
AU - Pitt, Susan C.
N1 - Funding Information:
The authors thank Brittany Hayes, MA, for her assistance with data collection.
Publisher Copyright:
© 2021 American College of Surgeons
PY - 2021/9
Y1 - 2021/9
N2 - Background: Informed consent is an ethical and legal requirement that differs from informed decision-making—a collaborative process that fosters participation and provides information to help patients reach treatment decisions. The objective of this study was to measure informed consent and informed decision-making before major surgery. Study design: We audio-recorded 90 preoperative patient-surgeon conversations before major cardiothoracic, vascular, oncologic, and neurosurgical procedures at 3 centers in the US and Canada. Transcripts were scored for 11 elements of informed consent based on the American College of Surgeons’ definition and 9 elements of informed decision-making using Braddock's validated scale. Uni- and bivariate analyses tested associations between decision outcomes as well as patient, consultation, and surgeon characteristics. Results: Overall, surgeons discussed more elements of informed consent than informed decision-making. They most frequently described the nature of the illness, the operation, and potential complications, but were less likely to assess patient understanding. When a final treatment decision was deferred, surgeons were more likely to discuss elements of informed decision-making focusing on uncertainty (50% vs 15%, p = 0.006) and treatment alternatives (63% vs 27%, p = 0.02). Conversely, when surgery was scheduled, surgeons completed more elements of informed consent. These results were not associated with the presence of family, history of previous surgery, location, or surgeon specialty. Conclusions: Surgeons routinely discuss components of informed consent with patients before high-risk surgery. However, surgeons often fail to review elements unique to informed decision-making, such as the patients’ role in the decision, their daily life, uncertainty, understanding, or patient preference.
AB - Background: Informed consent is an ethical and legal requirement that differs from informed decision-making—a collaborative process that fosters participation and provides information to help patients reach treatment decisions. The objective of this study was to measure informed consent and informed decision-making before major surgery. Study design: We audio-recorded 90 preoperative patient-surgeon conversations before major cardiothoracic, vascular, oncologic, and neurosurgical procedures at 3 centers in the US and Canada. Transcripts were scored for 11 elements of informed consent based on the American College of Surgeons’ definition and 9 elements of informed decision-making using Braddock's validated scale. Uni- and bivariate analyses tested associations between decision outcomes as well as patient, consultation, and surgeon characteristics. Results: Overall, surgeons discussed more elements of informed consent than informed decision-making. They most frequently described the nature of the illness, the operation, and potential complications, but were less likely to assess patient understanding. When a final treatment decision was deferred, surgeons were more likely to discuss elements of informed decision-making focusing on uncertainty (50% vs 15%, p = 0.006) and treatment alternatives (63% vs 27%, p = 0.02). Conversely, when surgery was scheduled, surgeons completed more elements of informed consent. These results were not associated with the presence of family, history of previous surgery, location, or surgeon specialty. Conclusions: Surgeons routinely discuss components of informed consent with patients before high-risk surgery. However, surgeons often fail to review elements unique to informed decision-making, such as the patients’ role in the decision, their daily life, uncertainty, understanding, or patient preference.
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U2 - 10.1016/j.jamcollsurg.2021.05.029
DO - 10.1016/j.jamcollsurg.2021.05.029
M3 - Article
C2 - 34102279
AN - SCOPUS:85111018841
SN - 1072-7515
VL - 233
SP - 337
EP - 345
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 3
ER -