Assessing the adequacy of procedure-specific consent forms in orthopaedic surgery against current methods of operative consent

Barritt, Andrew W; Clark, Laura; Teoh, Victoria; Cohen, Adam Max; Gibb, Paul

doi:10.1308/003588410x12628812458257

Cited by 31 publications

(30 citation statements)

References 6 publications

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“…Several alternatives to the typical consent form and process have been suggested in the literature. Barritt et al [17] reported that procedure-specific consent forms were superior to generic consent forms for both knee arthroscopy and total knee replacement for patient understanding. Finch et al [18] conducted a randomised control trial for consent for transurethral resection of prostate, comparing the conventional consent against procedure-specific consent forms produced by the British Association of Urological Surgeons.…”

Section: Discussionmentioning

confidence: 99%

Consent: an event or a memory in lumbar spinal surgery? A multi-centre, multi-specialty prospective study of documentation and patient recall of consent content

McAuley

Gillies

et al. 2017

Eur Spine J

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Study design Prospective, multi-centre, multi-specialty medical notes review and patient interview. Purpose The consenting process is an important communication tool which also carries medico-legal implications. While written consent is a pre-requisite before spinal surgery in the UK, the standard and effectiveness of the process have not been assessed previously. This study assesses standard of written consent for elective lumbar decompressive surgery for degenerative disc disease across different regions and specialties in the UK; level of patient recall of the consent content; and identifies factors which affect patient recall. Methods Consent forms of 153 in-patients from 4 centres a, b, c, d were reviewed. Written documentation of intended benefits, alternative treatments and operative risks was assessed. Of them, 108 patients were interviewed within 24 h before or after surgeries to assess recall. Results The written documentation rates of the operative risks showed significant inter-centre variations in haemorrhage and sphincter disturbance (P = 0.000), but not for others. Analysis of pooled data showed variations in written documentation of risks (P \ 0.0005), highest in infection (96.1%) and lowest in recurrence (52.3%). For patient recall of these risks, there was no inter-centre variation. Patients' recall of paralysis as a risk was highest (50.9%) and that of recurrence was lowest (6.5%). Patients \65 years old recalled risks better than those C65, significantly so for infection (29.9 vs 9.7%, P = 0.027). Patients consented [14 days compared to \2 days before their surgeries had higher recall for paralysis (65.2 vs 43.7%) and recurrence (17.4 vs 2.8%). Patient recall was independent of consenter grade. Conclusion Overall, the standard of written consent for elective lumbar spinal decompressive surgery was suboptimal, which was partly reflected in the poor patient recall. While consenter seniority did not affect patient recall, younger age and longer consent-to-surgery time improved it.

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Section: Discussionmentioning

confidence: 99%

Consent: an event or a memory in lumbar spinal surgery? A multi-centre, multi-specialty prospective study of documentation and patient recall of consent content

McAuley

Gillies

et al. 2017

Eur Spine J

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“…The advantages of procedure‐specific consent forms have been assessed by orthopaedic surgeons as well. Barritt et al . reported that by using procedure‐specific consent forms for knee arthroscopy and total knee replacement, the level of patients' understanding was significantly improved.…”

Section: Discussionmentioning

confidence: 99%

Audit on surgical patients' understanding of their informed consent

et al. 2015

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Aim:The aim of the present study was to assess patients' understanding of their informed consent to surgery preoperatively. Appropriate completeness of essential items in the written consent form was also verified. Patients and Methods: An audit was conducted from March to May 2013 at a university teaching hospital. All participants were adult surgical patients. Operations were confined to major category on elective basis performed under general anaesthesia. The first part of the audit consisted of a structured questionnaire with five questions concerning their understanding and perception of the surgery. In the second part of the audit, the completeness of all fundamental items entered into the standardized written consent form was verified. Results: A total of 100 surgical patients were studied, with a median age of 61 years (range: 22-89). A total of 99 per cent of participants could state the correct name and site of the procedure, and 92 per cent could state the mode of anaesthesia. Only 39 per cent of patients received an information leaflet regarding the operation, of which 80 per cent claimed this could enhance their understanding of the procedure. Only 70 per cent of them could recall the potential surgical risks. Most essential items were completed in the consent forms. Witnesses were involved only in 24 per cent of cases. Illegible surgeons' handwriting was observed in 6 per cent of consent documents. Conclusions: Most patients could understand the nature and site of the operation they were going to receive. The provision of relevant information to our patients preoperatively was insufficient. Patients had limited recall of the potential surgical risks. There is room for improvement in the present informed consent process.

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“…One method to improve these is to convey standardised information using procedure specific consent forms 19 . This approach has been reported to improve recall rates in patients undergoing knee arthroscopy and arthroplasty 20 . The variability of the information recorded on ordinary consent forms by junior staff lends support to the use of such printed and standardised consent forms 12,20,21 .…”

Section: Discussionmentioning

confidence: 99%

The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures

Khan

Karuppaiah

Bajwa

2012

annals

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INTRODUCTIONInformed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified ‘poor consent’ as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures.METHODSA prospective study was conducted at a tertiary unit. Fifty NOF patients (cases) and fifty total hip replacement (THR) patients (controls) were assessed for process factors (adequacy and validity of consent) as well as patient factors (comprehension and retention) using consent forms and structured interview proformas.RESULTSThe two groups were matched for ASA (American Society of Anesthesiologists)grade and AMTS. The consent forms were adequate in both groups but scored poorly for validity in the NOF group. Only 26% of NOF patients remembered correctly what surgery they had while only 48% recalled the risks and benefits of the procedure. These results were significantly poorer than in THR patients (p=0.0001).CONCLUSIONSThis study confirms that NOF patients are poor at remembering the information conveyed to them at the time of consent when compared with THR patients despite being intellectually and physiologically matched. We suggest using pre-printed consent forms (process factors), information sheets and visual aids (patient factors) to improve retention and recall.

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Assessing the adequacy of procedure-specific consent forms in orthopaedic surgery against current methods of operative consent

Abstract: Providing patients with an Orthoconsent form significantly improves knowledge of their planned procedure as well as constituting a more robust means of information provision and consent documentation.

Cited by 31 publications

References 6 publications

Consent: an event or a memory in lumbar spinal surgery? A multi-centre, multi-specialty prospective study of documentation and patient recall of consent content

Consent: an event or a memory in lumbar spinal surgery? A multi-centre, multi-specialty prospective study of documentation and patient recall of consent content

Audit on surgical patients' understanding of their informed consent

The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures

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