Informed Consent

Kraushar, Marvin F.; Steinberg, James A.

doi:10.1001/archopht.1986.01050150052025

Cited by 17 publications

(3 citation statements)

References 7 publications

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“…The importance of obtaining proper informed consent is paramount both in terms of ensuring that patients understand the risks, benefits, and alternatives to interventions and procedures and also for the practical purpose of reducing malpractice risk due to improper or inadequate consenting processes [32]. The informed consent process should serve to educate patients not only about the risks of the intervention planned, but also the risks of nonintervention [33,34].…”

Section: Discussionsupporting

confidence: 44%

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Malpractice Litigation in Ocular Oncology

et al. 2017

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Aims: The aim of this study was to report and analyze the causes and outcomes of ocular oncology malpractice litigation. Methods: The WestLaw® database was reviewed for all litigation related to ophthalmology in the United States from 1930 to 2014. All ocular oncology cases were included in this analysis and compared to other ophthalmic subspecialties. Results: Sixteen ocular oncology malpractice cases were included in this study. Overall, 56.3% of the cases were resolved in favor of the defendant. A total of 62.5% of cases were resolved via jury verdict, with 30.0% resulting in plaintiff verdicts with mean adjusted awards of USD 511,244.48, comparable to ophthalmology as a whole. Three cases (18.8%) resulted in settlements with mean adjusted indemnities of USD 828,928.14. A total of 87.5% of cases alleged insufficient intervention resulting in loss of vision and/or death. The most common clinical entities were uveal melanoma (31.3%), retinoblastoma (12.5%), and sebaceous cell carcinoma (12.5%). Conclusions: Ocular oncology malpractice litigation was relatively rare and outcomes generally favored defendants; however, unlike other subspecialties in ophthalmology, blindness or premature death were common to all cases, highlighting both the importance of prompt diagnosis and treatment and the difficulty inherent in diagnosing ocular malignancies.

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Section: Discussionsupporting

confidence: 44%

“…Additionally, patients should be informed of the possibility that surgical plans may shift intraoperatively, a discussion which may have prevented at least 1 case in this series. Ensuring that patients understand these risks increases patient satisfaction and informs patients' expectations [32,34]. …”

Section: Discussionmentioning

confidence: 49%

Malpractice Litigation in Ocular Oncology

et al. 2017

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“…This underscores the importance of good doctor-patient communication in the consent process. However, in an increasingly litigious climate, this communication runs the risk of becoming an act primarily to serve the physician’s legal defence (Krausher and Steinberg 1986; Fernando et al 2007), undermining other important aspects of patient care. Patients may be burdened with unsolicited information about what might go wrong for the sake of explicit documentation of having being told.…”

Section: Introductionmentioning

confidence: 99%

Should patients set the agenda for informed, consent? A prospective survey of desire for information and discussion prior to routine cataract surgery

Tan

Jenkins²,

Roberts-Harry³

et al. 2008

TCRM

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Purpose:To ascertain the level of information relating to specifi c risks desired by patients prior to cataract surgery. Setting: Dedicated cataract surgery pre-assessment clinics of 2 hospitals in South West Wales, UK. Methods: Consecutive patients (106) were recruited prospectively. Of these, 6 were formally excluded due to deafness or disorientation. Eligible patients (100) were asked a set of preliminary questions to determine their understanding of the nature of cataract, risk perception, and level of information felt necessary prior to giving consent. Those who desired further information were guided through a standardized questionnaire, which included an audio-visual presentation giving information relating to each potential surgical complication, allowing patients to rate them for relevance to their giving of informed consent. Results: Of the entire group of 100, 32 did not wish to know "anything at all" about risks and would prefer to leave decision making to their ophthalmologist; 22 were interested only in knowing their overall chance of visual improvement; and 46 welcomed a general discussion of possible complications, of whom 25 went on to enquire about specifi c complications. Of these 25, 18 wished to be informed of posterior capsular (PC) tearing, 17 of endophthalmitis, 16 each of dropped lens, retinal detachment and corneal clouding, and 15 of bleeding, sympathetic ophthalmia, and PC opacifi cation. Conclusion: Patients differ in their desire for information prior to cataract surgery, with one signifi cant minority favoring little or no discussion of risk and another wishing detailed consideration of specifi c risks. A system of consent where patients have a choice as to the level of discussion undertaken may better suit patients' wishes than a doctor-specifi ed agenda.

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Informed Consent and Decision Making by Cataract Patients

Kiss¹

2004

Arch Ophthalmol

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To investigate decision making by patients on the day before cataract surgery and to evaluate to what extent the informed consent process influences the patients' decision regarding consent. Methods: On the day before surgery, 70 patients (mean±SD age, 70.3±10.3 years) underwent a standardized informed consent procedure. They were also invited to answer 15 questions established in interdisciplinary cooperation among clinical psychologists, lawyers, and ophthalmologists. Main Outcome Measures: We assessed presurgical information and personal estimation of risks in cataract surgery; the patient-physician relationship regarding surgery-related decisions; and evaluations of the informed consent procedure and the patients' decision. Results: Questionnaire answers indicated that 28 (40%) of the 70 participating patients arrived for surgery without any information; 16 (23%) believed that there were surgical procedures without risks; and 53 (76%) estimated that there were no risks for their cataract surgery. A physician-dominated decision for surgery was preferred by 31 patients (44%); 16 (26%) wanted to decide together with their ophthalmologist. Possible risks of a sight-threatening complication did not influence 54 patients' (77%) decisions, and 55 patients (78%) said the informed consent process did not influence their decision. The remaining 15 (22%) stated that the informed consent process positively confirmed their decision. Conclusions: Informed consent 1 day preoperatively does not seem to influence the decision for cataract surgery. Cognitive dissonance as part of a decision-making process makes changes in an already chosen option unlikely. The resulting limited decisive potential is very important for credibility in a trial and has to be considered in ophthalmologic surgery.

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Informed Consent

Cited by 17 publications

References 7 publications

Malpractice Litigation in Ocular Oncology

Malpractice Litigation in Ocular Oncology

Should patients set the agenda for informed, consent? A prospective survey of desire for information and discussion prior to routine cataract surgery

Informed Consent and Decision Making by Cataract Patients

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