Kiss Christopher G, Richter-Mueksch Sibylla, Stifter Eva, Diendorfer-Radner Gabriela, Velikay-Parel Michaela, Radner Wolfgang
Department of Ophthalmology and Optometry, University of Vienna, Vienna, Austria.
Arch Ophthalmol. 2004 Jan;122(1):94-8. doi: 10.1001/archopht.122.1.94.
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.
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.
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.
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.
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.
调查白内障手术前一天患者的决策情况，并评估知情同意过程在多大程度上影响患者关于同意手术的决策。
手术前一天，70名患者（平均年龄±标准差为70.3±10.3岁）接受了标准化的知情同意程序。他们还被邀请回答由临床心理学家、律师和眼科医生跨学科合作制定的15个问题。
我们评估了白内障手术前的信息及对手术风险的个人估计；与手术相关决策的医患关系；对知情同意程序及患者决策的评估。
问卷调查答案显示，70名参与患者中有28名（40%）在未了解任何信息的情况下前来手术；16名（23%）认为存在无风险的手术操作；53名（76%）估计自己的白内障手术没有风险。31名患者（44%）倾向于由医生主导手术决策；16名（26%）希望与眼科医生共同决策。视力威胁性并发症的潜在风险并未影响54名患者（77%）的决策，55名患者（78%）表示知情同意过程未影响他们的决策。其余15名（22%）表示知情同意过程肯定了他们的决策。
术前一天的知情同意似乎并未影响白内障手术的决策。作为决策过程一部分的认知失调使得改变已选择的方案不太可能。由此产生的有限决策潜力对于试验的可信度非常重要，在眼科手术中必须予以考虑。
