Amount and quality of information received by patients who agreed to coordinated surgeries
Keywords:
GENERAL SURGERY, INFORMED CONSENTAbstract
Introduction: informed consent implies an interaction and communication process whereby the amount and quality of the information provided is essential for it to be valid. The information received by patients is not always appropriately decoded, understood or remembered.
Objetives: 1. To learn about the information the patient is able to transmit once it has agreed to a coordinated surgery procedure that falls into the category of major or high surgery.
2. To determine whether patients knew the pre-surgical diagnosis, the suggested surgical treatment, the possible complications and diagnosis prior to surgery, and whether they were willing to learn more about their disease or the proposed surgery.
Method: we selected a convenience sample of 60 patients who were admitted for major or high surgery and had received information and accepted the proposed treatment. A five question form was used.
Results: patients selected were 39 women and 21 men. Average age: 59 years and 7 months (19-84 years old). Most patients (n=55) stated they had been informed about their disease. In 11 cases, the disease described verbally did not coincide with the diagnosis. Cases where the disease was ignored and the diagnosis differed from the information corresponded to oncologic patients.
In cases where consent to treatment had already been given, treatment was unknown to 13 patients. Most patients (n=33) were not fully aware of the treatment’s risks. Most patients stated they were not interested in asking more questions or learning more, although ten wished to ask questions.
Discussion: a significant number of patients did not receive or was unable to remember or verbally express information for the making of decisions, what could have resulted from the scarce and/or low quality information or from factors that depend on the patient – such as refusal upon anguish generated by the disease and its prognosis. A patronizing or condescending bias that is accepted in the current Uruguayan reality was recognized. Ignorance of treatment cannot be justified and it implies an ethical problem and a medico-legal risk for surgeons.
Conclusions: a significant percentage of patients lacked appropriate and sufficient information after having given consent to major or higher surgery, in writing and having subscribed the relevant record. We need to deepen the study of the causes of failure in the informed consent process. It is advisable for surgeons to know about these weaknesses and to improve the information processes with the purpose of protecting their patients’ rights and to perform safer surgeries.
References
(2) Rodríguez H. Seudoconsentimiento informado en Uruguay. Rev Med Urug 2002; 18(1): 89-93.
(3) Childers R, Lipsett PA, Pawlik TM. Informed consent and the surgeon. J Am Coll Surg 2009; 208(4): 627-34.
(4) González D, Rodríguez H, Berro G. Consentimiento informado. Análisis crítico de su aplicación en un servicio quirúrgico. Rev Méd Urug 2005; 21(4): 291-7.
(5) Galán Cortés JC. La responsabilidad médica y el consentimiento informado. Rev Méd Urug 1999; 15(1): 5-12.
(6) Rodríguez H. Los aspectos críticos de la responsabilidad médica y su prevención. Rev Méd Urug 2001; 17(1):17-23.
(7) Galán Cortés JC. Responsabilidad médica y consentimiento informado. Madrid: Civitas, 2001: 744.
(8) Vaccarino JM. Consent, informed consent and the consent form. N Engl J Med 1978; 298(8): 455.
(9) Simón Lorda P. Diez mitos en torno al consentimiento informado. An Sist Sanit Navar 2006; 29(Sup.3): 29-40.
(10) Felley C, Perneger TV, Goulet I, Rouillard C, Azar-Pey N, Dorta G, et al. Combined written and oral information prior to gastrointestinal endoscopy compared with oral information alone: a randomized trial. BMC Gastroenterol 2008; 8: 22.
(11) Kusec S, Oreskovic S, Skegro M, Korolija D, Busic Z, Horzic M. Improving comprehension of informed consent. Patient Education and Counseling 2006; 60(3): 294-300.
(12) Tuveri M, Caocci G, Efficace F, Medas F, Collins GS, Pisu S. Different perception of surgical risks between physicians and patients undergoing laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2009; 19(4): 305-11.
(13) Cockcroft S, Sandhu N, Norris A. How does national culture affect citizens’ rights of access to personal health information and informed consent? Health Informatics J 2009; 15(3): 229-43.
(14) Ghulam AT, Kessler M, Bachmann LM, Haller U, Kessler TM. Patients’ satisfaction with the preoperative informed consent procedure: a multicenter questionnaire survey in switzerland. Mayo Clin Proc 2006; 81(3): 307-12.
(15) Falagas ME, Korbila IP, Giannopoulou KP, Kondilis BK, Peppas P. Informed consent: how much and what do patients understand? Am J Surg 2009; 198(3): 420-35.
(16) Amoroso S, Cabo P, Pérez Suquilvide L. El paciente con cáncer. In: Cesarco R. Aportes prácticos a la medicina psicosocial. Montevideo: UMPS, 1990: 83-96.
(17) Musé I. El consentimiento escrito como distorsión de la relación médico-paciente. In: Sindicato Médico del Uruguay. II Jornadas de responsabilidad médica (1996). Montevideo: SMU, 1998: 141-5.
(18) Sosa T. Relación vinculante entre médico paciente: el consentimiento. In: Sindicato Médico del Uruguay. II Jornadas de responsabilidad médica (1996). Montevideo: SMU, 1998: 147-52.
(19) Labrador F, Bara E. La información del diagnóstico a pacientes con cáncer. Psicooncología 2004; 1(1): 51-66.
(20) Szafir D, Venturini B. Responsabilidad médica en el MERCOSUR. Montevideo: FCU, 1997: 510.
(21) Gustafson D, Arora N, Nelson E, Boberg E. Increasing understanding of patient needs during and after hospitalization. Jt Comm J Qual Improv 2001; 27(2): 81-92.
(22) Watson M. Psychosocial intervention with cancer patients: a review. Psychol Med 1983; 13(4): 839-46.
