Informed Consent and Decision Making by Cataract Patients

Abstract

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.

The consent and counselling of patients for cataract surgery: a prospective audit

“…18,19 Despite increased pressures for clinicians to practise a patientrights-based approach to informed consent, it was apparent that a significant proportion of patients demonstrated a reluctance/inability to partake in the shared decisions relating to their management; a similar finding to previous studies. 8,20 It is difficult to produce any recommendations from this audit about the ideal frequency, timing and explicitness of patient counselling since some of the findings may be due to the poor statistical power of the small patient numbers involved in each cycle. Repeating both cycles of this audit with larger patient numbers in each cycle would help resolve some of these issues, as would the introduction of quantitative analysis to study the influences of frequency of counselling, explicitness of counselling and other modalities of patient information, for example, patient information videos.…”

“…These findings of poor patient comprehension are in keeping with other recent studies. 8 The surgeon cannot assume that patients who have had previous cataract surgery to be more informed or less anxious than 'first eye' patients. None of the patients undergoing second eye surgery could give a correct description of a cataract; although they they were more aware that surgery was intraocular and required IOL implantation.…”

“…7 Others contend that this is poor practice by not allowing the patient time to consider the management options fully. 8 Regardless of timing, for consent to be considered valid, it must be implemented as a process and not just a single event and this is reflected in the opinion that the documentation of preoperative doctor-patient discussions about proposed management is seen as greater medicolegal defence than a consent form signed just prior to surgery. 6 Recently, in seeking patients' consent: the ethical considerations, 9 the GMC moved the UK medical profession closer to the American principle of informed consent.…”

“…13,14 Indeed, it has been shown that many patients prefer to abstain from taking part in management decisions regarding their care. 8 Thus some surgeons practise a paternalistic approach to the consent process; based on the belief that as long as the medicolegal requirements of valid informed consent have been met via previously performed documented preoperative counselling, further explicit counselling about the potential risks and complications, for the sake of obtaining a patient's signature on the consent form, should be avoided.…”

Ophthalmic residents' surgical training: a study of patient perspective and attitudes in a teaching hospital in India

“…6 Many authors have discussed the best practices for eliciting informed consent through information leaflets, videos, personal interactions and generic proforma. [7][8][9][10][11] However, the more contentious issue of disclosure and discussion of resident training in consent procedures has not achieved much attention, as many surgeons feel that since cataract surgery is an elective surgical procedure, detailed communication with the patients at the time of eliciting informed consent regarding the need and extent of resident participation in their care and the training objectives of the institution may lead the patient to refuse treatment and seek care elsewhere where resident training is not the mandate. They suggest evoking altruistic response from the patient regarding the need for surgical training in society without discussing specific details.…”