Surgeon clinical practice variation and patient preferences during the informed consent discussion: a mixed-methods analysis in lumbar spine surgery

Abstract

Background: Patients with lumbar disc herniation may greatly benefit from microdiscectomy. Although spine surgeons performing microdiscectomy routinely obtain informed consent, the potential adverse events they disclose often vary. Moreover, little is known about what disclosures are deemed most valuable by patients. The aim of this mixed-methods study was to determine practice variations among spine surgeons in regard to the disclosure of potential adverse events during informed consent discussions for lumbar microdiscectomy and to determine which topics patients perceived to be valuable in the consent discussion. Methods: A survey evaluating the frequency with which spine surgeons disclose 15 potential adverse events related to lumbar microdiscectomy during informed consent discussions was distributed among Canadian Spine Society members. Additionally, semi structured interviews were conducted with preoperative patients, postoperative patients, attending spine surgeons, spine fellows and orthopedic residents. Interview transcripts were analyzed using thematic analysis with open coding. Results: Fifty-one Canadian Spine Society members completed the survey. The number of potential adverse events not routinely discussed was greater among orthopedic surgeons than among neurosurgeons (relative risk 1.83; 95% confidence interval 1.22-2.73; p = 0.003). Three preoperative patients, 7 postoperative patients, 6 attending spine surgeons, 3 spine fellows and 5 orthopedic residents participated in the semi structured interviews. The interviews identified gaps in information provided to patients, particularly on topics relating to postoperative care such as expected recovery time, activity restrictions and need for a caregiver. Conclusion: There is variation in the disclosure of potential adverse events during informed consent discussions for lumbar microdiscectomy among Canadian spine surgeons. Patients desire more information regarding their postoperative care. Further research should focus on developing guidelines to reduce practice variation and optimize the effectiveness of consent discussions. Contexte : Les patients atteints d'une hernie discale lombaire pourraient profiter grandement d'une microdiscectomie. Bien que les chirurgiens spécialistes de la colonne vertébrale réalisant des microdiscectomies obtiennent toujours le consentement éclairé du patient, les événements indésirables potentiels présentés varient souvent. De plus, on en connaît peu sur les informations les plus importantes du point de vue des patients. L'objectif de cette étude à méthodes mixtes était de déterminer les différentes pratiques des chirurgiens en ce qui a trait à la présentation des événements indésirables potentiels pendant les discussions sur le consentement éclairé pour les microdiscectomies lombaires et de déterminer les sujets les plus importants pour les patients pendant ces discussions. Méthodes : Un sondage sur la fréquence à laquelle les chirurgiens présentent 15 événements indésirables potentiels associés à la microdiscectomie l...

Patient and Spine Surgeon Perceptions on Shared Decision-Making in the Treatment of Older Adults Undergoing Corrective Surgery for Adult Spinal Deformity

“…One study explored the sources of expectations in patients undergoing lumbar sur-gery 9 Another study used both surgeon and patient interviews to determine variations in disclosure of adverse events during informed consent for lumbar microdiscectomy pro-cedures. 10 While both offer insight into improved processes for SDM, the current literature does not address how SDM may influence patient satisfaction and decisional regret. A previous study by our group showed that one in five patients expressed decisional regret following deformity correction surgery.…”

“…Previous studies in the spine literature are limited to specific elements of decision-making or patient education. One study explored the sources of expectations in patients undergoing lumbar sur-gery 9 Another study used both surgeon and patient interviews to determine variations in disclosure of adverse events during informed consent for lumbar microdiscectomy pro-cedures 10 . While both offer insight into improved processes for SDM, the current literature does not address how SDM may influence patient satisfaction and decisional regret.…”

Telling the truth to patients before hip fracture surgery

“…Despite these legal and ethical obligations, executing the informed consent process remains a challenge, especially in orthopedic surgery [8]. Malpractice claims often highlight inadequate disclosure of procedure risks [9], a deficiency attributed to various factors such as physicians' aversion to delivering negative news, emotional discomfort, uncertainty regarding outcomes, and time constraints, particularly in urgent cases such as hip fractures [10,11].…”

Telling the whole truth to patients before hip fracture repair surgery. Cross sectional study.

“…In addition, failure to disclose the risks of a procedure in the informed consent process is associated with increased indemnity risk [5]. In contrast, there is evidence that well-informed patients are more satis ed, have a more effective recovery, and le fewer legal claims [9].…”