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SAN FRANCISCO – Recent surveys of patients and attending surgeons show differing views on disclosures, Dr. Susan Lee Char said at the clinical congress of the American College of Surgeons.
She and her associates surveyed 353 adult patients at their first postoperative clinic visit and 85 attending surgeons at hospitals affiliated with the University of California, San Francisco. The survey presented a hypothetical case of a patient’s undergoing elective partial hepatectomy and asked respondents to rate the importance of receiving or conveying various items of information on a 6-point Likert scale.
In all, 79% of patients said it’s essential to know if their surgeon would be doing a procedure for the first time on them, but only 55% of attending surgeons felt this was important information to disclose. A total of 63% of patients considered it essential to know the number of times a surgeon had performed a particular procedure and the outcomes in those cases, compared with just 25% and 20% of surgeons, respectively.
"The data suggest that surgeons do have an ethical obligation to disclose volumes and outcomes and if it’s the first time [they’re] doing a procedure," said Dr. Char, a surgical resident at the university who is also a lawyer. "This has possible legal implications."
The main barrier to surgeons’ disclosure may be a practical one, she added. Surgeons often don’t have data on the volumes and outcomes of their procedures.
Patients’ and attending surgeons’ perceptions of the importance of other types of information also differed significantly. A general description of the procedure was rated as important by 65% of patients vs. 58% of surgeons, and technical details of the procedure were important to 48% of patients and 13% of surgeons. Disclosure of risks and benefits of the procedure were deemed essential by 77% and 71% of patients, respectively, compared with 72% and 65% of surgeons, respectively. A total of 41% of patients and 5% of surgeons said the patient should be told the number of times the procedure has been done by other surgeons, and 44% of patients and 20% of surgeons said other surgeons’ outcomes should be disclosed.
A total of 64% of patients and 31% of surgeons believed it was important to discuss any special training by the surgeon doing the procedure. Some 64% of patients said they would want to be informed about the surgeon’s special training for a standard procedure, compared with 68% for a laparoscopic procedure and 71% for a robotic procedure.
Technological innovation made a difference in whether patients deemed certain information essential. Patients scheduled for a laparoscopic or robotic procedure were significantly more likely to want information than those undergoing a standard operation.
In all, 63% of patients said they would want to know the number of times that a standard procedure had been done by their surgeon. That percentage rose to 66% for a laparoscopic procedure and to 68% for a robotic procedure. Outcomes information was considered important by 63% of patients for a standard procedure, 66% for a laparoscopic procedure, and 67% for a robotic procedure. And 24% of patients, compared with 6% of surgeons, said the patient should be told if the surgeon planned to publish an article including the case. Disclosing whether a surgeon is a paid consultant was less important to patients (5%) than to surgeons (40%).
Dr. Char had no conflicts of interest.
This study is an important one for all practicing surgeons. Informed consent is central to the practice of surgery, and disclosure of information is a cornerstone of the consent process. Nevertheless, as Dr. Char’s study so dramatically illustrates, surgeons and patients frequently disagree on which items must be disclosed in order to obtain informed consent.
A few important areas of discrepancy are revealed. For example, patients considered disclosure of how many times a surgeon had performed a specific procedure more important than did surgeons. Similarly, only 55% of surgeons thought it was important to disclose to patients whether they were performing an operation for the first time, whereas 79% of patients said that such information was essential. On the other hand, despite the national movement to disclose financial conflicts of interest, only 5% of patients wanted to know if their surgeon was a paid consultant to industry compared with 40% of surgeons who felt that this is important to disclose.
What conclusions should we draw from these discrepancies between what patients say they want to know and what surgeons say is important to disclose in the informed consent process? Most important, surgeons should realize the difficulties we have in accurately predicting what information will be important to our patients. If we assume that we know how much information our patients want, we will almost certainly guess incorrectly. As a result, a different strategy should be adopted. Surgeons should tailor their disclosure in the consent process to the specific information needs of the individual patient. This can readily be accomplished by asking, "What additional questions do you have?" or "What information do you need in order to feel comfortable consenting to this operation?" If surgeons were to be guided by their patients when tailoring the nature and amount of information they disclose, patients would more likely be satisfied with that disclosure and the consent process would be improved.
Dr. Peter Angelos is an ACS Fellow, professor of surgery, and associate director, MacLean Center for Clinical Medical Ethics, University of Chicago.
This study is an important one for all practicing surgeons. Informed consent is central to the practice of surgery, and disclosure of information is a cornerstone of the consent process. Nevertheless, as Dr. Char’s study so dramatically illustrates, surgeons and patients frequently disagree on which items must be disclosed in order to obtain informed consent.
A few important areas of discrepancy are revealed. For example, patients considered disclosure of how many times a surgeon had performed a specific procedure more important than did surgeons. Similarly, only 55% of surgeons thought it was important to disclose to patients whether they were performing an operation for the first time, whereas 79% of patients said that such information was essential. On the other hand, despite the national movement to disclose financial conflicts of interest, only 5% of patients wanted to know if their surgeon was a paid consultant to industry compared with 40% of surgeons who felt that this is important to disclose.
What conclusions should we draw from these discrepancies between what patients say they want to know and what surgeons say is important to disclose in the informed consent process? Most important, surgeons should realize the difficulties we have in accurately predicting what information will be important to our patients. If we assume that we know how much information our patients want, we will almost certainly guess incorrectly. As a result, a different strategy should be adopted. Surgeons should tailor their disclosure in the consent process to the specific information needs of the individual patient. This can readily be accomplished by asking, "What additional questions do you have?" or "What information do you need in order to feel comfortable consenting to this operation?" If surgeons were to be guided by their patients when tailoring the nature and amount of information they disclose, patients would more likely be satisfied with that disclosure and the consent process would be improved.
Dr. Peter Angelos is an ACS Fellow, professor of surgery, and associate director, MacLean Center for Clinical Medical Ethics, University of Chicago.
This study is an important one for all practicing surgeons. Informed consent is central to the practice of surgery, and disclosure of information is a cornerstone of the consent process. Nevertheless, as Dr. Char’s study so dramatically illustrates, surgeons and patients frequently disagree on which items must be disclosed in order to obtain informed consent.
A few important areas of discrepancy are revealed. For example, patients considered disclosure of how many times a surgeon had performed a specific procedure more important than did surgeons. Similarly, only 55% of surgeons thought it was important to disclose to patients whether they were performing an operation for the first time, whereas 79% of patients said that such information was essential. On the other hand, despite the national movement to disclose financial conflicts of interest, only 5% of patients wanted to know if their surgeon was a paid consultant to industry compared with 40% of surgeons who felt that this is important to disclose.
What conclusions should we draw from these discrepancies between what patients say they want to know and what surgeons say is important to disclose in the informed consent process? Most important, surgeons should realize the difficulties we have in accurately predicting what information will be important to our patients. If we assume that we know how much information our patients want, we will almost certainly guess incorrectly. As a result, a different strategy should be adopted. Surgeons should tailor their disclosure in the consent process to the specific information needs of the individual patient. This can readily be accomplished by asking, "What additional questions do you have?" or "What information do you need in order to feel comfortable consenting to this operation?" If surgeons were to be guided by their patients when tailoring the nature and amount of information they disclose, patients would more likely be satisfied with that disclosure and the consent process would be improved.
Dr. Peter Angelos is an ACS Fellow, professor of surgery, and associate director, MacLean Center for Clinical Medical Ethics, University of Chicago.
SAN FRANCISCO – Recent surveys of patients and attending surgeons show differing views on disclosures, Dr. Susan Lee Char said at the clinical congress of the American College of Surgeons.
She and her associates surveyed 353 adult patients at their first postoperative clinic visit and 85 attending surgeons at hospitals affiliated with the University of California, San Francisco. The survey presented a hypothetical case of a patient’s undergoing elective partial hepatectomy and asked respondents to rate the importance of receiving or conveying various items of information on a 6-point Likert scale.
In all, 79% of patients said it’s essential to know if their surgeon would be doing a procedure for the first time on them, but only 55% of attending surgeons felt this was important information to disclose. A total of 63% of patients considered it essential to know the number of times a surgeon had performed a particular procedure and the outcomes in those cases, compared with just 25% and 20% of surgeons, respectively.
"The data suggest that surgeons do have an ethical obligation to disclose volumes and outcomes and if it’s the first time [they’re] doing a procedure," said Dr. Char, a surgical resident at the university who is also a lawyer. "This has possible legal implications."
The main barrier to surgeons’ disclosure may be a practical one, she added. Surgeons often don’t have data on the volumes and outcomes of their procedures.
Patients’ and attending surgeons’ perceptions of the importance of other types of information also differed significantly. A general description of the procedure was rated as important by 65% of patients vs. 58% of surgeons, and technical details of the procedure were important to 48% of patients and 13% of surgeons. Disclosure of risks and benefits of the procedure were deemed essential by 77% and 71% of patients, respectively, compared with 72% and 65% of surgeons, respectively. A total of 41% of patients and 5% of surgeons said the patient should be told the number of times the procedure has been done by other surgeons, and 44% of patients and 20% of surgeons said other surgeons’ outcomes should be disclosed.
A total of 64% of patients and 31% of surgeons believed it was important to discuss any special training by the surgeon doing the procedure. Some 64% of patients said they would want to be informed about the surgeon’s special training for a standard procedure, compared with 68% for a laparoscopic procedure and 71% for a robotic procedure.
Technological innovation made a difference in whether patients deemed certain information essential. Patients scheduled for a laparoscopic or robotic procedure were significantly more likely to want information than those undergoing a standard operation.
In all, 63% of patients said they would want to know the number of times that a standard procedure had been done by their surgeon. That percentage rose to 66% for a laparoscopic procedure and to 68% for a robotic procedure. Outcomes information was considered important by 63% of patients for a standard procedure, 66% for a laparoscopic procedure, and 67% for a robotic procedure. And 24% of patients, compared with 6% of surgeons, said the patient should be told if the surgeon planned to publish an article including the case. Disclosing whether a surgeon is a paid consultant was less important to patients (5%) than to surgeons (40%).
Dr. Char had no conflicts of interest.
SAN FRANCISCO – Recent surveys of patients and attending surgeons show differing views on disclosures, Dr. Susan Lee Char said at the clinical congress of the American College of Surgeons.
She and her associates surveyed 353 adult patients at their first postoperative clinic visit and 85 attending surgeons at hospitals affiliated with the University of California, San Francisco. The survey presented a hypothetical case of a patient’s undergoing elective partial hepatectomy and asked respondents to rate the importance of receiving or conveying various items of information on a 6-point Likert scale.
In all, 79% of patients said it’s essential to know if their surgeon would be doing a procedure for the first time on them, but only 55% of attending surgeons felt this was important information to disclose. A total of 63% of patients considered it essential to know the number of times a surgeon had performed a particular procedure and the outcomes in those cases, compared with just 25% and 20% of surgeons, respectively.
"The data suggest that surgeons do have an ethical obligation to disclose volumes and outcomes and if it’s the first time [they’re] doing a procedure," said Dr. Char, a surgical resident at the university who is also a lawyer. "This has possible legal implications."
The main barrier to surgeons’ disclosure may be a practical one, she added. Surgeons often don’t have data on the volumes and outcomes of their procedures.
Patients’ and attending surgeons’ perceptions of the importance of other types of information also differed significantly. A general description of the procedure was rated as important by 65% of patients vs. 58% of surgeons, and technical details of the procedure were important to 48% of patients and 13% of surgeons. Disclosure of risks and benefits of the procedure were deemed essential by 77% and 71% of patients, respectively, compared with 72% and 65% of surgeons, respectively. A total of 41% of patients and 5% of surgeons said the patient should be told the number of times the procedure has been done by other surgeons, and 44% of patients and 20% of surgeons said other surgeons’ outcomes should be disclosed.
A total of 64% of patients and 31% of surgeons believed it was important to discuss any special training by the surgeon doing the procedure. Some 64% of patients said they would want to be informed about the surgeon’s special training for a standard procedure, compared with 68% for a laparoscopic procedure and 71% for a robotic procedure.
Technological innovation made a difference in whether patients deemed certain information essential. Patients scheduled for a laparoscopic or robotic procedure were significantly more likely to want information than those undergoing a standard operation.
In all, 63% of patients said they would want to know the number of times that a standard procedure had been done by their surgeon. That percentage rose to 66% for a laparoscopic procedure and to 68% for a robotic procedure. Outcomes information was considered important by 63% of patients for a standard procedure, 66% for a laparoscopic procedure, and 67% for a robotic procedure. And 24% of patients, compared with 6% of surgeons, said the patient should be told if the surgeon planned to publish an article including the case. Disclosing whether a surgeon is a paid consultant was less important to patients (5%) than to surgeons (40%).
Dr. Char had no conflicts of interest.
Major Finding: Only 55% of surgeons believed they should disclose that they would be doing a surgery for the first time on a patient when getting informed consent, compared with 79% of patients.
Data Source: Surveys presenting a hypothetical case to 353 patients at postoperative clinic visits, and to 85 attending surgeons.
Disclosures: Dr. Char said she has no relevant conflicts of interest.