Beyond consent—improving understanding in surgical patients

doi:10.1016/j.amjsurg.2010.12.010

The American Journal of Surgery

Volume 203, Issue 1, January 2012, Pages 112-120

https://doi.org/10.1016/j.amjsurg.2010.12.010 Get rights and content

Abstract

Background

Little is known of the actual understanding that underlies patient choices with regard to their surgical treatment. This review explores current knowledge of patient understanding and techniques that may be used to improve this understanding.

Methods

MEDLINE and PubMed were searched using the terms “patient understanding,” “patient comprehension,” “consent,” “video,” “multimedia,” “patient information leaflet,” “internet,” “test-feedback,” “extended discussion,” “shared decision making,” and “decision aid.” All retrieved peer-reviewed studies were included in the review.

Results

Understanding in surgical patients is poor. There is little evidence to support the use of information leaflets, although multimedia appears to be effective in improving patient understanding. The internet is not used effectively as an aid to consent by health care providers. Patients with lower educational levels may gain most from additional interventions. Improving patient understanding does not impact on their satisfaction with the treatment they have received but may reduce periprocedural anxiety.

Conclusions

There is a need for greater awareness of patients' information needs, and novel approaches that may enhance decision making through improved understanding are required.

Section snippets

Methods

A literature search was performed using the MEDLINE and PubMed databases to identify articles reporting assessment of understanding in patients consenting to surgical intervention. The following medical subject headings (MeSH) headings were used: “patient understanding,” “patient comprehension,” and “consent.” The search was expanded used the “Related articles” function in PubMed and through cross-references from retrieved articles. All retrieved articles in English reporting understanding in

Understanding in Surgical Patients

In routine clinical practice, patient understanding often is presumed and rarely formally assessed. Braddock et al15, 16 developed a model to assess 9 key elements of the informed decision-making process and analyzed taped doctor–patient discussions. They found that an assessment of patient understanding is rarely performed and that most decisions fail to meet the criteria for informed decision making.

Studies designed to formally assess understanding have shown that patients frequently are

Improving Patient Understanding

A number of tools have been assessed as adjuncts to decision making and consent with a view to improving patient understanding.

Comments

Appropriately assisting informed decision making by patients is a professional obligation of the surgeon.⁷⁵ Facilitating patients in shared decision making may help them make choices in keeping with their preferences and values, particularly when the evidence or clinical scenario do not clearly point to a particular treatment option.⁷⁶

Our review of the available literature suggests that surgical patients are often poorly informed about their condition and treatment, and are ill-equipped to make

Conclusions

Understanding in patients undergoing surgical treatment is poor. Awareness of methodologies such as the informed decision making model may help surgeons to structure and appraise their consultations. Surgeons should have greater awareness of patient factors that may impact on understanding such as age and education. Those with lower levels of education, and those whose initial understanding is poorest, may stand to gain the most from additional educational measures such as multimedia tools at

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View full text

ReviewBeyond consent—improving understanding in surgical patients

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Understanding in Surgical Patients

Improving Patient Understanding

Comments

Conclusions

Patient Educ Couns

J Vasc Surg

Eur J Surg Oncol

Br J Oral Maxillofac Surg

Patient Educ Couns

Lancet

Br J Plast Surg

Patient Educ Couns

Arthroscopy

Eur J Surg Oncol

J Psychiatr Res

Surgeon

J Am Coll Surg

J Am Coll Surg

Cardiovasc Surg

Smith v Tunbridge Wells Health Authority 5 Med LR 334

Chester v Afshar

Geoghegan v Harris

Reducing medication errors and increasing patient safety: case studies in clinical pharmacology

J Clin Pharmacol

Patients' perceptions of written consent: questionnaire study

BMJ

Informed consent for elective and emergency surgery: questionnaire study

Br J Obstet Gynaecol

Women's accounts of consenting to surgery: is consent a quality problem?

Qual Saf Health Care

A typology of shared decision making, informed consent, and simple consent

Ann Intern Med

Is informed consent in cardiac surgery and percutaneous coronary intervention achievable?

Aust N Z J Surg

Factors affecting quality of informed consent

BMJ

An evaluation of patients comprehension of orthopaedic terminology: implications for informed consent

J R Coll Surg Edinb

Informed decision making in outpatient practice: time to get back to basics

JAMA

“Surgery is certainly one good option”: quality and time-efficiency of informed decision-making in surgery

J Bone Joint Surg Am

Patients' assessment and recall of surgical information after laparoscopic cholecystectomy

Dig Surg

Informed consent in cardiac surgery: is it truly informed?

J Cardiovasc Med [Hagerstown]

Informed consent: how much information is enough?

Aust N Z J Surg

Informed consent: patients listen and read, but what information do they retain?

N Z Med J

Impact of the informed consent process on patients' understanding of varicose veins and their treatment

Ir J Med Sci

Informed consent for abdominal aortic aneurysm repair: the patient's perspective

J Vasc Surg

Patients' recall of preoperative instruction for informed consent for an operation

J Bone Joint Surg Am

Surgeons underestimate their patients' desire for preoperative information

World J Surg

How do patients' treatment preferences compare with those of clinicians?

Qual Health Care

Patients' values and clinical substituted judgments: the case of localized prostate cancer

Health Psychol

Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study

BMJ

Information needs and decisional preferences in women with breast cancer

JAMA

Information and decision-making preferences of men with prostate cancer

Oncol Nurs Forum

Preferences for outcomes of treatment for rectal cancer: patient and clinician utilities and their application in an interactive computer-based decision aid

Dis Colon Rectum

What do patients want? Patient preferences and surrogate decision making in the treatment of colorectal cancer

Dis Colon Rectum

Review
Beyond consent—improving understanding in surgical patients