Patient perceptions and recall of consent for regional anaesthesia compared with consent for surgery

Abstract

SummaryObjective: In Britain, consent for surgery is documented using a Department of Health form signed by the surgeon and the patient. In contrast, anaesthetic procedures have no formalised consent process. Evidence on the process of consent for regional anaesthesia, and patient perceptions of this, is scarce outside obstetric practice. We aimed to determine patient recall and perceptions of consent for interscalene brachial plexus block and compared this to surgical consent for shoulder arthroplasty. Design: Prospective observational survey. Setting: A specialist musculoskeletal centre, UK. Participants: Forty-six patients (female:male 30:16, mean age 61 years) undergoing shoulder arthroplasty with interscalene brachial plexus block. Main outcome measures: Recall and understanding of consent for regional anaesthesia and surgery was examined using a semi-structured questionnaire 1-2 days after arthroplasty. Surgical consent forms and discussions recorded by the anaesthetist were examined in participants' medical notes to compare against the level of recall. Analysis to determine statistical significance was conducted using McNemar's test. Results: Recall of surgical risks was overall significantly better than recall of brachial plexus block risks. Compared to their recollections of surgical risk, patients remembered fewer specific risks for brachial plexus block (p < 0.001). There were more patients unable to recall any risks when questioned about brachial plexus block than about their surgery (p < 0.05). One-third of patients did not regard the consent discussion about regional anaesthesia as important as consent for surgery and over one-quarter had not recognised the preoperative discussion about the brachial plexus block as a consent process similar to that conducted for surgery. Conclusions: Fundamental misunderstandings about the consent process are prevalent. Future work in this area should seek to investigate how documentation of the consent process and patients' understanding of consent for regional anaesthesia can be improved.

A Review of Consent Practices and Perspectives for Pharmacogenetic testing

“…For example, a discussion about testing may not be viewed by patients with the same gravitas as a signed consent form, or patients may fail to recognize it as part of the consent process [62]. Also, the information disclosed in patient-provider discussion may vary substantially due to providers' knowledge [63][64][65][66], so provider education is essential and discussion tips may help standardize discussions.…”

Efficacy and quality of informed consent for Dacryocystorhinostomy–a prospective study

“…Retention of surgical indications, procedure details and especially recall of risks have been used in previous studies to assess consent. 10,12,13 We used similar parameters in our study to objectively assess informed consent, as well as patient satisfaction of the consenting process. Every patient had a standard discussion with an appropriate clinician and opportunity to ask questions, receiving the same hospital information leaflet at their initial consultation.…”

Say what? Patients have poor immediate memory of major risks of interscalene block disclosed during the informed consent discussion

“…Zarnegar and colleagues previously conducted a small (n=46) survey to compare memory of risks related to ISB compared with those related to surgery, which were disclosed prior to shoulder arthroplasty. 6 These investigators found that patients had poor memory of ISB risks, with almost half of the participants unable to identify a single risk that had been previously disclosed. However, several methodological shortcomings undermine the study's validity, including incomplete and heterogeneous risk disclosure, inconsistent documentation of the consent discussions, lack of consideration for participants' language and educational levels, small sample size, and possible recall bias due to the prolonged delay between risk disclosure and subsequent memory assessment and data collection.…”