Improving the Consent Process in Foot and Ankle Surgery With the Use of Personalized Patient Literature

Howard, Nicholas; Cowan, Chris; Ahluwalia, Raju; Wright, Andrew; Hennessy, Michael S.; Jackson, Gillian; Platt, Simon

doi:10.1053/j.jfas.2017.08.011

Cited by 9 publications

(3 citation statements)

References 13 publications

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“…Although there was very poor overall recall of risk in this study, what was particularly notable was that 30% of patients could not recall a single risk at a 4-week interval (consent nonresponders). This finding is not unique to our study, with multiple other article reporting that between 30% and 50% of participants could not recall a single risk after consent at follow-up of 4 weeks or less 5,15,24,34,35 . This phenomenon is likely multifactorial in nature, with the passage of time, 16,21,23 a limited ability to understand the information provided at the time of consenting, and a preference for not wanting to know about the technical aspects of surgery including complications 36,37 all contributing.…”

Section: Discussionmentioning

confidence: 61%

Influence of a Preadmission Procedure-Specific Consent Document on Patient Recall of Informed Consent at 4 Weeks After Total Hip Replacement: A Randomized Controlled Trial

2020

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Objectives: Consent is a legal and ethical requirement for undertaking surgical procedures; however, the literature suggests that there continues to be poor recall among patients of the surgical risks discussed during the consent process. The aim of this study was to evaluate whether the addition of a preadmission procedure-specific consent document would improve patient recall of surgical risks at 4 weeks after total hip replacement in patients consented with a procedure-specific consent form.Methods: A prospective randomized controlled trial allocated seventy adult patients who were undergoing a primary total hip replacement to either receive (intervention group) or not receive (control group) a preadmission procedure-specific consent document. All patients were also consented with a procedure-specific consent form on the morning of surgery and were contacted 4 weeks later to assess recall of surgical risks.Results: There was a very poor recall rate seen in both the intervention group (16%) and the control group (13%), with no statistically significant difference between them (P = 0.49). A large number (30%) of patients could not recall a single risk. A subgroup analysis excluding these "consent nonresponders" did show a significantly increased recall rate in the intervention group (24.5% versus 18.25%, P = 0.02).Conclusions: Patient recall of potential complications of total hip replacement was poor despite the intervention. Although not effective overall, the use of a preadmission procedure-specific consent document did improve recall of potential complications of surgery in a subset of patients. The phenomenon of consent nonresponders is worth exploring in future research.

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Section: Discussionmentioning

confidence: 61%

Influence of a Preadmission Procedure-Specific Consent Document on Patient Recall of Informed Consent at 4 Weeks After Total Hip Replacement: A Randomized Controlled Trial

2020

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“…Our findings demonstrate that pre- and post-operative education prior to TAR or ankle fusion was often insufficient and there was variability in the type of information provided. Written information has been shown to facilitate understanding among patients awaiting foot and ankle surgery [ 25 ] but not all participants in our study were provided with sufficient written information. Some participants sought further information about their surgical procedure from the Internet, similar to those in previous studies [ 7 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“I could have a proper ankle” – a qualitative study of patients' perceptions of total ankle replacement and ankle fusion surgery

Anderson

Chapman

Siddle

et al. 2022

Journal of Foot and Ankle Research

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Background End-stage ankle osteoarthritis typically causes severe pain and impaired function. Surgical treatment involves total ankle replacement (TAR) or ankle fusion. Definitive evidence about which procedure is optimal is lacking. No previous studies have thoroughly explored patients’ experiences across the entire TAR/ankle fusion pathway. This study aimed to address this gap by exploring perceptions of surgery, education, rehabilitation and outcomes among patients who had undergone TAR or ankle fusion. Methods Seven participants were purposively selected from an orthopaedic centre in northern England (3 females, 4 males). Participants had undergone primary TAR without revision (n = 2), TAR requiring revision (n = 3) or ankle fusion (n = 2). Each participant completed a single semi-structured interview. Interviews were digitally recorded, transcribed verbatim and analysed thematically. Results Three themes, each with two subthemes, were identified: decision-making (seeking help; surgical options), perceptions of support (information/education; clinical support) and impact on the individual (personal circumstances and beliefs; post-operative outcomes). Pain affecting participants’ valued activities was key to their decision to seek help. Participants’ decision between TAR and ankle fusion was influenced by multiple factors. Concerns regarding the lack of joint flexibility following fusion were highlighted, with some participants perceiving TAR as a “proper ankle” that would enable them to avoid limping. Participants obtained information from various sources, with most feeling that the education from their care team was inadequate. Participants’ individual circumstances and beliefs influenced their decision-making and perceptions of their post-operative outcomes. Finally, whilst most participants were pleased with their outcomes, some experienced substantial ongoing problems such as difficulty walking and chronic pain. Conclusions This study demonstrates the importance of providing adequate education about TAR and ankle fusion to enable patients to make informed decisions. Most participants felt that the education and clinical support they received did not fully meet their needs. Participants’ personal circumstances and beliefs had a strong influence on their decision-making and perceptions of their post-operative outcomes, highlighting the need to personally tailor education and clinical support. Future work with a larger sample of patients and other key stakeholders is required to develop consensus-based guidelines on pre- and post-operative support for patients undergoing TAR/ankle fusion.

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“…Increasing literature reports that virtual patient education results in improved patient recall of the consent process and procedure in question [ 13 , 15 ]. However, no such data is available in relation to orthopaedic surgeons when obtaining informed consent in written form [ 12 , 16 ]. Close observation of more senior colleagues, textbook review of potential operative approaches and complications or even virtual or electronic learning offer some understanding to trainee doctors in obtaining informed consent; however, Halstedian models often still apply [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Informed Written Consent for Orthopaedic Trauma in the Emergency Setting at a Tertiary Referral Centre: A Closed-Loop Audit

Davey¹,

Davey²,

Mohan³

et al. 2021

Cureus

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Introduction The purpose of this investigation was to perform an audit of the standards of consent forms in which patients sign prior to operative intervention for orthopaedic trauma in an emergency setting in our institution, with comparison to the ‘Orthopaedic Surgical Consent’ standards, as set by the American Association of Orthopaedic Surgeons (AAOS) . If required, the investigator aimed to close the loop in this audit by educating orthopaedic surgeons on the necessary standards of obtaining written consent for orthopaedic trauma. Methods Following being granted approval by our institutional audit committee, a pre-intervention cycle was performed to assess the quality of consent obtained in written format using electronic patient records in consecutive patients over a four-week period. Following the analysis of this data, an education session was provided for all orthopaedic doctors responsible for obtaining informed written consent from patients who are planned to undergo operative management of a soft tissue or bony injury by the trauma and orthopaedic service in the emergency setting. Thereafter, a post-intervention cycle was performed with subsequent descriptive analysis using the GraphPad software. Results In the pre-intervention audit cycle, all included (n = 107) consent forms (100%) correctly included the patient’s name, date of birth (DOB) and institutional board number (BN). However, only 79 consent forms (74.5%) were completed without using abbreviations or acronyms of any kind, whilst 81 consent forms (76.4%) were completed without correctly stating the side or site of the planned intervention. In the post-intervention cycle, all included (n = 40) consent forms (100%) correctly included the patient’s name, DOB and institutional BN. Additionally, a total of 37 consent forms (92.5%) were correctly completed without using abbreviations or acronyms of any kind (74.5% versus 92.5%, p = 0.02). Furthermore, a total of 39 consent forms (97.5%) were completed correctly stating the side or site of the planned intervention (76.4% versus 97.5%, p = 0.0015). Conclusion This closed-loop audit found that the quality of informed consent obtained by orthopaedic surgeons in the emergency setting might potentially be significantly improved with at least one virtual education session. Such simple education sessions may potentially improve the documentation of the planned potential operative intervention by orthopaedic surgeons for cases of orthopaedic trauma to ensure patient safety is optimised. As the turnover of non-consultant hospital doctors is high in university teaching hospitals, regular education sessions on such topics may introduce a cultural shift in maintaining high standards when marking and consenting patients in the emergency setting.

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Improving the Consent Process in Foot and Ankle Surgery With the Use of Personalized Patient Literature

Cited by 9 publications

References 13 publications

Influence of a Preadmission Procedure-Specific Consent Document on Patient Recall of Informed Consent at 4 Weeks After Total Hip Replacement: A Randomized Controlled Trial

Influence of a Preadmission Procedure-Specific Consent Document on Patient Recall of Informed Consent at 4 Weeks After Total Hip Replacement: A Randomized Controlled Trial

“I could have a proper ankle” – a qualitative study of patients' perceptions of total ankle replacement and ankle fusion surgery

Informed Written Consent for Orthopaedic Trauma in the Emergency Setting at a Tertiary Referral Centre: A Closed-Loop Audit

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