Khan Saad U, Bowrey David J, Williams Robert N, Soh Jun Yi, Peleki Aikaterini, Muhibullah Nazli, Waterland Peter W
Russells Hall Hospital, University Hospitals of Leicester, 18 Glebe Road, Leicester, LE6 0GT, UK.
University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, LE1 5WW, UK.
Ann Med Surg (Lond). 2018 Sep 25;35:67-72. doi: 10.1016/j.amsu.2018.09.033. eCollection 2018 Nov.
Informed consent obtained for day case surgery has been historically incomplete. An assessment of consenting practice for groin hernia was performed relative to existing gold standards and patient's perception of the consent process was evaluated with a questionnaire. The aim of the study was to identify areas of improvement to comply with best practice.
A retrospective audit of adult patients undergoing groin hernia repair (June-November 2016) at a tertiary care centre was performed. The same cohort of patients was surveyed with a self-administered questionnaire to identify their view on consenting practice.
113 patients were identified who underwent groin hernia repair during the study period. Pre-printed consent templates-stickers (as opposed to hand-written) were used in 53(47%) cases. In 75(66%) cases, there was complete documentation of the risks and benefits of surgery. 81(72%) patients received information about the full benefits of surgery. 27(23%) patients received partial information and 7(6%) patients had no mention of benefit recorded. Postoperative recovery was fully explained to 85(75%) patients. Use of pre-printed templates ensured 100% documentation compared to handwritten consent forms (risks 37%, benefits 47%, and recovery 53%). Preference for the timing of consent was in clinic (64%), day of surgery (25%). 34(56%) felt the choice for the technique and 22(36%) felt the choice for anaesthesia. Satisfaction was non-significantly better in those consented in clinic (87% versus 76% p = 0.74). 49(80%) felt happy with the overall consent process. 57(93%) felt that they received support and advice. 60(98%) responders felt confidence in the National Health Service and 59(97%) would recommend treatment to family and friends.
The use of pre-printed consent and discharge summary templates improve compliance with best practice. Whilst patient preference favours consent in the outpatient clinic, satisfaction levels were high wherever consent was obtained. Patients should have more choice.
日间手术的知情同意历来不完整。针对腹股沟疝的同意程序，根据现有的黄金标准进行了评估，并通过问卷调查评估了患者对同意程序的看法。本研究的目的是确定需要改进的方面，以符合最佳实践。
对一家三级医疗中心2016年6月至11月接受腹股沟疝修补术的成年患者进行回顾性审计。对同一组患者进行了一份自我管理的问卷调查，以了解他们对同意程序的看法。
在研究期间，共识别出113例接受腹股沟疝修补术的患者。53例（47%）使用了预先印制的同意模板贴纸（而非手写）。75例（66%）病例中，手术风险和益处有完整记录。81例（72%）患者了解了手术的全部益处。27例（23%）患者获得了部分信息，7例（6%）患者未记录有益处相关内容。85例（75%）患者被告知术后恢复的详细情况。与手写同意书相比，使用预先印制的模板可确保100%的记录（风险方面为37%，益处方面为47%，恢复方面为53%）。同意的时间偏好为在诊所（64%）、手术当天（25%）。34例（56%）认为技术选择由自己决定，22例（36%）认为麻醉选择由自己决定。在诊所同意的患者满意度略高，但差异无统计学意义（87%对76%，p = 0.74）。49例（80%）对总体同意程序感到满意。57例（93%）觉得自己得到了支持和建议。60例（98%）受访者对国民医疗服务体系有信心，59例（97%）会向家人和朋友推荐该治疗。
使用预先印制的同意书和出院小结模板可提高对最佳实践的依从性。虽然患者更倾向于在门诊诊所获得同意，但无论在何处获得同意，满意度都很高。患者应有更多选择。
