Risks of elective cardiac surgery: what do patients want to know?

Abstract

Objective-To examine patients' individual requirements for risk disclosure before surgery. Design-Structured interview and questionnaire. Setting-50 patients interviewed following coronary artery bypass grafting or valve replacement or repair. Main outcome measures-Patient assessment of the nature and probability of risks they would have wished to be informed of from a pool comprising death and 13 postoperative complications. Results-Out of 50 patients, 21 (42%) wanted no risk information at all, 25 (50%) did not want to be advised of the risk of death, and 27 (54%) did not want information about the risk of permanent stroke. This contrasts with standard practice of routinely informing patients of the risk of death and stroke. However, there were pronounced individual patient preferences. Three groups of patients emerged: those requiring little or no risk information, those requiring information about major risks, and those requiring full risk disclosure. Patients were not generally concerned about the specific probabilities of any risk. Conclusions-Clinicians counselling patients before operation should routinely discuss patient preferences before risk disclosure, distinguishing among a preference for "no risk information", "all potentially relevant risks", and "those risks considered significant or likely to occur". The fact of individual patient preferences may undermine the concept of the "reasonable patient" in determination of the legal requirements for risk disclosure. Future studies, in addition to replicating the present findings, should examine the reasons underlying individual patient preferences and the long term implications of degrees of risk disclosure, particularly when adverse outcomes occur. (Heart 2001;86:626-631)

Extended written pre-operative information about possible complications at cardiac surgery—do the patients want to know?

“…They were designed on the basis of a literature review [3,11,12]. The questionnaires consisted of Likert-type questions and multiple-choice questions about information on complications (14 items), personal attitude to information (2 items), and possibility for support (3 items).…”

“…Patients have different opinions regarding whether they want information about risks or not. One study showed that in 50 patients facing cardiac surgery, 42% wanted no information at all about the risks associated with the surgery and 50% did not want any information about the risk of death [3]. Even though the decision regarding cardiac surgery is crucial, most patients leave the decision to the surgeon.…”

Guideline on preventing entry-related gynaecological laparoscopic injuries: post-publication reflections of the senior author

“…In an interesting paper by Beresford et al reflecting on what patients wished to know about the risks of elective cardiac surgery, they concluded that the understanding and acceptance of the risk associated with the procedure may be different from that of women having procedures for life-threatening conditions [10]. In another survey on women's views about the risks of laparoscopy, Kennedy and his group from Oxford University presented evidence from women undergoing diagnostic laparoscopy for pelvic pain suggested that they do want to know all the possible complications [11].…”

Risk perception and implantable cardioverter defibrillators

“…A further barrier to risk communication and informed consent is that nearly half of patients undergoing CABG do not want to know about the risk of death or stroke associated with the procedure. 12 Most of those who do want to be informed of the risk of death are not concerned with specific probabilities. .…”