Patient Safety and Translational Research Centre, Imperial College London, London, UK.
Patient Safety and Translational Research Centre, Imperial College London, London, UK.
J Surg Res. 2019 Mar;235:298-302. doi: 10.1016/j.jss.2018.09.046. Epub 2018 Nov 3.
Despite the ethical and statutory requirement to obtain consent for surgical procedures, the actual process itself is less well defined. The degree of disclosure and detail expected may vary greatly. A recent shift toward a more patient-centered approach in both clinical and medico-legal practice has significant implications for ensuring appropriate and legal practice in obtaining informed consent before surgery.
Two hundred patients undergoing elective surgery across two hospitals returned a survey of attitudes toward consent, perceived important elements in the consent process, and risk tolerance, as well as demographic details.
No significant associations between patient demographics and survey responses were found. Patients were least concerned with the environment in which consent was taken and the disclosure of uncommon complications. The most important factors related to communication and rapport between clinician and patients, as opposed to procedure- or complication-specific items. A majority of patients preferred risks to be described using proportional descriptors, rather than percentage or non-numeric descriptors.
Risk tolerance and desired level of disclosure varies for each patient and should not be presumed to be covered by standardized proformas. We suggest an individualized approach, taking into account each patient's background, understanding, and needs, is crucial for consent. Communications skills must be prioritized to ensure patient satisfaction and reduced risk of litigation.
尽管手术程序需要获得同意，但实际的同意过程并没有明确的规定。期望的披露程度和详细程度可能会有很大差异。最近，在临床和医疗法律实践中，一种更加以患者为中心的方法发生了转变，这对确保在手术前获得知情同意方面的适当和合法做法具有重要意义。
在两家医院接受择期手术的 200 名患者对同意书的态度、对同意过程中重要因素的看法、风险承受能力以及人口统计细节进行了调查。
未发现患者人口统计学特征与调查结果之间存在显著关联。患者最不关心的是同意书的签署环境以及罕见并发症的披露。与手术或并发症相关的具体项目相比，与医患沟通和融洽关系相关的因素更为重要。大多数患者更喜欢使用比例描述符来描述风险，而不是百分比或非数字描述符。
每个患者的风险承受能力和期望的披露程度都不同，不应假定标准化表格涵盖了所有内容。我们建议采取个性化的方法，考虑到每个患者的背景、理解和需求，这对于同意至关重要。必须优先考虑沟通技巧，以确保患者满意度并降低诉讼风险。
