Informed consent for elective surgery—what is best practice?

Anderson, Owen A.; Wearne, I Mike J

doi:10.1177/014107680710000226

Cited by 69 publications

(86 citation statements)

References 7 publications

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“…According to the law, the patient must be informed about the diagnosis and its uncertainties, the purpose, benefits and risks of the recommended treatment, other treatment choices and their benefits and risks, and potential complications (1,2,(4)(5)(6)(7)(11)(12)(13)(14). With sufficient information, the patient can decide whether or not to go ahead with the surgery, knowing the risks of refusing or accepting the treatment (1,5,13).…”

Section: Discussionmentioning

confidence: 99%

“…It is hard to decide how many details should be given to a patient who is about to undergo a surgery, especially one with a high risk of failure or adverse side effects. Although there are a number of guidelines, the issue of how much to explain to a patient undergoing surgery is still unclear (4,7,11,12). There are some serious complications that are extremely rare and not routinely mentioned by some doctors, who know that a reasonable patient can have doubts and even decline the procedure after learning all the risks they are accepting by having the surgery (7).…”

Section: Discussionmentioning

confidence: 99%

“…It is the patient's right to get adequate information about the risks and benefits of a surgical procedure (1,2). The surgeon must preoperatively warn the patient of the potential risks of the procedure and treatment and must be sure that the patient is competent enough to understand and accept common or serious side effects and serious or frequently occurring risks, even the ones that can have adverse grave consequences (1)(2)(3)(4)(5). Preoperative patient information should include diagnosis, treatment, risks, and further course of the illness to enable the patient to make his or her own decision on having the surgery (1,2).…”

Section: Introductionmentioning

confidence: 99%

“…Too much information about potential surgical complications can lead a minority of patients to have doubts and even decline the operation; alternatively, too little information fails to adequately inform patients before they sign the informed consent form (4,7,10,11). In some cases, the surgeon may prefer not to mention serious or frequently occurring risks that may cause a reasonable patient to decline the surgery (4).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Healthy subjects’ knowledge of surgical complications: a hospital-based survey

Yalçın¹,

Dumlu²,

Tokaç³

et al. 2015

Turk J Med Sci

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Background/aim: There is an ongoing debate about how much a patient should know about serious or frequently occurring risks of their surgery. In this study, we evaluated healthy subjects' perspectives on knowledge of serious surgical complications.Materials and methods: Three hundred and thirty healthy subjects (151 women, 179 men; mean age: 43.6 ± 17.3 years) were surveyed with the study questionnaire. Social profile, surgical history of the healthy subjects, and presence of a relative while giving preoperative consent were assessed.Results: Only 23.5% (39/166) of the subjects were informed about all the potential complications of their previous surgical operation and 44.9% (73/166) did not get any preoperative consent on surgical complications. A statistically significant percentage of subjects who did not get proper information about the serious complications involved in their surgery indicated a desire for preoperative informed consent (97.0%, 128/132, P = 0.0001). Conclusion:The results indicated that a significant percentage of the subjects wanted to be informed of the potential complications of a surgery in the presence of a relative (73.9%, 192/260, P = 0.009). Involving a relative in preoperative consent may have a positive effect on the patient and can increase the level of postoperative recall of the risks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Healthy subjects’ knowledge of surgical complications: a hospital-based survey

Yalçın¹,

Dumlu²,

Tokaç³

et al. 2015

Turk J Med Sci

View full text Add to dashboard Cite

show abstract

“…35 Legal precedent in the United Kingdom (Chester vs. Afshar 2004) has established failure of notifying a serious adverse event with a risk greater than 1-2% as a breach in the duty of care. 31,42 As Consent for adhesive complications reviewed above, the risks from late adhesive complications are serious and well in excess of the accepted threshold where it could be considered a breach in the duty of care not to inform patients. This is reflected by an increasing burden from medicolegal claims arising from late adhesive complications.…”

Section: Legal Implications Of Late Complications From Adhesionsmentioning

confidence: 99%

Implications of late complications from adhesions for preoperative informed consent

2010

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SummaryThe process of informed consent is a critical aspect of the doctor-patient relationship. Doctors have a professional duty to provide patients with sufficient information if a treatment is associated with a significant risk. NHS guidelines advise doctors to mention risks that occur more frequently than 1-2% or risks that are serious even if the likelihood is very small. In the case of abdominal and pelvic surgery, risks can broadly be divided into early and late complications. Early complications, such as bleeding and infection, have a close temporal relationship with the operation. Such complications are routinely mentioned during the consent process. In contrast, postoperative adhesions cause changes in the normal anatomy that can adversely affect function many years and even decades after the original operation, leaving patients at lifelong risk for late complications. These late adhesive complications, namely bowel obstruction, mechanical female infertility and chronic pain, are often neglected during the consent process. However, the risks to patients from late adhesive complications are serious and well in excess of the accepted threshold where it could be considered a breach in the duty of care not to inform patients. This is reflected by a number of claims against the NHS based on consent issues regarding late adhesive complications of surgery. Therefore, late complications of surgery from adhesions should be included in the pre-operative consent process. This would decrease litigation costs but more importantly also underpins the doctor-patient relationship.

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Effect of informed consent on patients undergoing gastrointestinal surgery and living donor liver transplantation and on their relatives in a developing country

et al. 2018

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BackgroundInformed consent is a systematic process for obtaining permission before conducting a healthcare intervention. In a developing country, gaining informed consent is generally perceived to be a ritual only to comply with legal requirements. The present study examined this by assessing the process of informed consent in patients undergoing gastrointestinal surgery or living donor liver transplantation (LDLT) and their relatives, based on their comprehension and overall satisfaction, in India.MethodsAll patients undergoing any gastrointestinal surgery or LDLT procedure between August 2015 and July 2016 and their relatives were included, and were administered a structured questionnaire 5 days after the procedure.ResultsThe majority of patients (94·2 per cent) could recall the nature of their disease, the surgery performed (81·6 per cent) and anticipated complications (55·6 per cent). Among their relatives, these proportions were 97·8, 87·3 and 58·5 per cent respectively. Recall was associated with age, occupation and education among both patients and relatives. Patients undergoing LDLT, their donors and their relatives had better recall than those who had other gastrointestinal procedures (P < 0·001). Many patients found the process of informed consent useful and reassuring.ConclusionThe details and risks of an operation were understood by most of the patients, especially those undergoing liver transplantation. Patients from developing countries can generally understand ‘informed consent’, and value it.

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Informed consent for elective surgery—what is best practice?

Cited by 69 publications

References 7 publications

Healthy subjects’ knowledge of surgical complications: a hospital-based survey

Healthy subjects’ knowledge of surgical complications: a hospital-based survey

Implications of late complications from adhesions for preoperative informed consent

Effect of informed consent on patients undergoing gastrointestinal surgery and living donor liver transplantation and on their relatives in a developing country

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