Legal and psychological considerations for obtaining informed consent for reverse total shoulder arthroplasty

Abstract

This paper seeks to outline recent legal developments and requirements pertinent to obtaining informed consent. We argue that this is of particular relevance to patients considering a reverse total shoulder arthroplasty, due to the high complication rate associated with this procedure. By examining the cognitive processes involved in decision-making, and other clinician-related factors such as delivery of information, gender bias and conflict of interest, we explore some of the barriers that can undermine the processes of shared decision-making and obtaining genuine informed consent. We argue that these issues highlight the importance for surgeons in understanding the cognitive processes and other influential factors involved in patients' comprehension and decision-making. We recommend, based on strong evidence, that decision aids could prove useful in overcoming such challenges and could provide one way of mitigating the ethical, professional and legal consequences of failing to obtain proper informed consent. They are not widely used in orthopaedics at present, although it would be in the interests of both the surgeon and patient for such measures to be explored.

Comparative learning curves for early complications in anatomical and reverse shoulder arthroplasty

“…This demonstrates the importance of postoperative instructions, as well as patient selection and operative technique, all of which form part of surgeon experience and a learning curve. 20 A dislocation rate of 5% is comparable with others studies, with Zumstein's systematic review quoting an overall dislocation rate of 4.7%, 21 and Alentorn-Gel et al 22 quoting a dislocation rate of 4.4% in a systematic review of 1118 patients.…”

Comparable outcomes of reverse shoulder arthroplasty for proximal humerus fractures and for rotator cuff arthropathy in a predominantly asian population

“…With a better understanding of the trajectory of recovery after reverse shoulder arthroplasty for both rotator cuff arthropathy and proximal humerus fracture, surgeons will be better equipped when explaining to patient their rehabilitation progress and prognosis for obtaining proper informed consent before major shoulder surgery. 42 Nevertheless, the findings of our study should be interpreted in consideration of its limitations. This investigation was conducted within a single institution, hence limiting the external validity of our results.…”

Litigation analysis of medical damage after total knee arthroplasty: a case study based on Chinese legal database in the past ten years

“…Medical activities with patients' knowledge and consent can significantly reduce the risk of medical damage litigation, which has been confirmed by multiple studies [ 25 – 28 ]. Patients should be informed of the potential risks, damage, benefits, success probability and alternatives of the treatment regimen before treatment [ 29 ], including the risks associated with litigation. In some cases where the doctor's proportional responsibility was 0, there were still cases of payment due to insufficient notification.…”