Bhangu A, Hood E, Datta A, Mangaleshkar S
Department of Trauma and Orthopaedics, Russells Hall Hospital, Dudley, UK.
J Med Ethics. 2008 Nov;34(11):780-2. doi: 10.1136/jme.2008.024471.
Informed consent in the modern era is a common and important topic both for the well-informed patient and to prevent unnecessary litigation. However, the effectiveness of informed consent in trauma patients is an under-researched area. This paper aims to assess the differences in patient recall of the consent process and desire for information by performing a comparative analysis between orthopaedic trauma and elective patients.
Information from 41 consecutive elective operations and 40 consecutive trauma operations was collected on the first post-operative day.
100% of elective patients and 90% of trauma patients knew what operation they had received (p = 0.06). Overall recall of complications was poor, but was significantly lower in trauma patients compared with elective patients (62% vs 22%, p<0.001). 30% of trauma patients desired more information about their operation compared to 12% of elective patients (p = 0.049), although only 35% of trauma patients wanted written as well as verbal explanations, compared to 85% of elective patients p<0.001). Overall 100% of elective and 90% of trauma patients were happy with the consent process (p = 0.06). Subset analysis of neck of femur compared to other trauma patients showed that the above factors were not significantly different between the two groups.
Recall of complications in the trauma patients is significantly lower than in elective patients, although both groups scored poorly overall. Repeated verbal explanations should be reinforced with the option of additional information leaflets for trauma operations. Further research into the usefulness of DVDs for commonly performed operations is warranted, although official internet resources may be more cost-effective.
在现代社会，知情同意对于消息灵通的患者以及预防不必要的诉讼而言，都是一个常见且重要的话题。然而，创伤患者知情同意的有效性是一个研究不足的领域。本文旨在通过对骨科创伤患者和择期手术患者进行对比分析，评估患者对同意过程的回忆以及对信息需求的差异。
在术后第一天收集了连续41例择期手术和40例创伤手术的信息。
100%的择期手术患者和90%的创伤患者知道自己接受了什么手术（p = 0.06）。总体而言，对并发症的回忆较差，但创伤患者的回忆明显低于择期手术患者（62%对22%，p<0.001）。30%的创伤患者希望获得更多关于其手术的信息，而择期手术患者为12%（p = 0.049），不过只有35%的创伤患者希望获得书面和口头解释，而择期手术患者为85%（p<0.001）。总体而言，100%的择期手术患者和90%的创伤患者对同意过程感到满意（p = 0.06）。与其他创伤患者相比，股骨颈患者的亚组分析表明，两组之间上述因素无显著差异。
创伤患者对并发症的回忆明显低于择期手术患者，尽管两组总体得分都很低。对于创伤手术，应加强反复的口头解释，并可选择提供额外的信息传单。有必要进一步研究DVDs对常见手术的有用性，尽管官方互联网资源可能更具成本效益。
