A Review of Surgical Informed Consent: Past, Present, and Future. A Quest to Help Patients Make Better Decisions

Abstract

BackgroundInformed consent (IC) is a process requiring a competent doctor, adequate transfer of information, and consent of the patient. It is not just a signature on a piece of paper. Current consent processes in surgery are probably outdated and may require major changes to adjust them to modern day legislation. A literature search may provide an opportunity for enhancing the quality of the surgical IC (SIC) process.MethodsRelevant English literature obtained from PubMed, Picarta, PsycINFO, and Google between 1993 and 2009 was reviewed.ResultsThe body of literature with respect to SIC is slim and of moderate quality. The SIC process is an underestimated part of surgery and neither surgeons nor patients sufficiently realize its importance. Surgeons are not specifically trained and lack the competence to guide patients through a legally correct SIC process. Computerized programs can support the SIC process significantly but are rarely used for this purpose.ConclusionsIC should be integrated into our surgical practice. Unfortunately, a big gap exists between the theoretical/legal best practice and the daily practice of IC. An optimally informed patient will have more realistic expectations regarding a surgical procedure and its associated risks. Well-informed patients will be more satisfied and file fewer legal claims. The use of interactive computer-based programs provides opportunities to improve the SIC process.

An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC)

“…Our study identified considerable deficiencies in the current knowledge and attitudes of our doctors toward this very crucial area of doctor-patient communication. Surprisingly certain studies from institutions in the western countries such as the USA, Europe, Netherlands and New Zealand have also reported a lack of doctors' knowledge regarding the process of SIC (1,3,(7)(8)(9)(10). Less than ideal level of working knowledge and attitudes regarding SIC on part of our doctors indicates a case for their focused education regarding SIC.…”

“…The additional gains with the use of computer programs for SIC would include better structure, improved quality, diminished consultation time and stimulated patient commitment. The time and effort saved for busy surgeons can better used for answering specific queries and concerns of the patient in brief consultation sessions with the patients (1,21,22). In our study majority of doctors admitted that they did not employ any structured proforma for the SIC.…”

“…Since it is a crucial part of patient care, it needs to be standardized to conform to the accepted norms of the process. It will surely improve its quality, completeness, patient satisfaction, safety, and legal solidity (1,(23)(24)(25). Structured SIC form has been successfully implemented in the daily practice of doctors in other countries (15).…”

“…The preconditions for a valid SIC include the patient's competence and voluntariness for the procedure in question. The information provided must be adequate and comprehensible (1)(2)(3). The information provided should particularly include medical facts about the patient's condition, details of the proposed procedures, the potential risks and benefits of the procedure and the alternatives to the proposed procedure including the natural course of non-treatment.…”

Standardized information for living liver donors

“…6 Indeed, there is increasing support for such Web-based consent interventions within the field of surgery. 7 Such Web sites could deliver information in an accessible, lowliteracy manner in order to facilitate an informed decision-making process for prospective living liver donors.…”