Laccourreye Ollivier, Cauchois Régis, Werner Alfred
Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital européen Georges Pom- pidou, 20-40 rue Leblanc, 75015 Paris. ollivier.laccourreye@.egp.aphp.fr
Bull Acad Natl Med. 2008 Feb;192(2):405-19; discussion 419-20.
We prospectively analyzed patients' memorisation and interpretation of preoperative information on the risks of thyroidectomy. This study was conducted in an academic tertiary care referral center, based on an inception cohort of 280 patients who were consecutively informed of the risks of thyroidectomy (unilateral laryngeal immobility, bilateral laryngeal immobility, hypocalcemia, common surgical complications, and perioperative death) by the same surgeon during the period 2003-2006. Univariate analysis was used to identify factors affecting memorisation and interpretation of the information delivered. After being informed of the risks, 14.6% of patients declined surgery, and 5% decided to postpone the operation for a few months. Among the 215 patients who underwent thyroidectomy, 0.9% remembered all five risks, 17.2% three or four, 61.4% one or two, and 20.4% none. The number of risks remembered did not vary over time. Age, occupation, and the year of the analysis influenced memorisation. In the immediate post-operative period, 85.5% of the patients had a positive opinion and 45.1% a negative opinion of the preoperative information, and 35.3% simultaneously expressed positive and negative opinions. The number of preoperative visits and the interval between the final preoperative visit and surgery both affected the patients' interpretation of the information. Patient memorisation of information on surgical risks is poor, and this results in major stress for the patient. After receiving this information, a significant proportion of patients decide to forego surgery.
我们前瞻性地分析了患者对甲状腺切除手术风险的术前信息的记忆和理解情况。本研究在一家学术性三级医疗转诊中心进行,基于一个起始队列,该队列包含280例患者,在2003年至2006年期间由同一位外科医生连续告知他们甲状腺切除手术的风险(单侧喉返神经麻痹、双侧喉返神经麻痹、低钙血症、常见手术并发症和围手术期死亡)。采用单因素分析来确定影响所传递信息的记忆和理解的因素。在被告知风险后,14.6%的患者拒绝手术,5%的患者决定推迟手术几个月。在接受甲状腺切除手术的215例患者中,0.9%的患者记住了所有五项风险,17.2%的患者记住了三项或四项,61.4%的患者记住了一项或两项,20.4%的患者一项也没记住。记住的风险数量并未随时间变化。年龄、职业和分析年份影响记忆情况。在术后即刻,85.5%的患者对术前信息持正面看法,45.1%的患者持负面看法,35.3%的患者同时表达了正面和负面看法。术前就诊次数以及最后一次术前就诊与手术之间的间隔均影响患者对信息的理解。患者对手术风险信息的记忆较差,这给患者带来了很大压力。在收到这些信息后,相当一部分患者决定放弃手术。