Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2019 Sep;94(9):1786-1798. doi: 10.1016/j.mayocp.2019.02.026.
To compare recall of complications and surgical details discussed during informed consent and perception of the consent process in patients undergoing emergent vs elective surgery.
Studies were identified from PubMed, Cochrane, Web of Science, and Scopus from January 1, 1966, through April 18, 2018. Included studies compared patient recall and perception regarding informed consent in those undergoing emergent vs elective surgery. Pooled odds ratios (ORs) were calculated for recall of complications and surgical details, patient satisfaction, perception of sufficient information being delivered on surgical risks, report of having read written consent, and factors that interfered with consent.
Eleven observational studies (3178 patients) were included. The rate of recall of surgical complications (255 of 504 [50.6%] vs 321 of 446 [72.0%]; OR, 0.29; 95% CI, 0.11-0.80) was lower in patients undergoing emergent vs elective surgery. Meta-analysis revealed a decreased rate of patient satisfaction with the consent process (319 of 459 [69.5%] vs 882 of 1064 [82.9%]; OR. 0.53; 95% CI, 0.34-0.83) and fewer patients having read the consent form (130 of 395 [32.9%] vs 424 of 714 [59.4%]; OR, 0.35; 95% CI, 0.27-0.46) when undergoing emergent compared with elective surgery. Patients undergoing emergent surgery listed pain, analgesic medications, and fatigue as factors likely to interfere with consent.
Patients undergoing emergent surgery have poor recall of the informed consent process and surgical complications. Furthermore, patients report lower rates of satisfaction, and with fewer patients reading written consent documentation, our findings illuminate problems with the current communication process. There is a need to develop effective tools to improve informed consent in emergency surgery.
比较接受紧急手术和择期手术的患者在知情同意过程中对讨论的并发症和手术细节的回忆以及对知情同意过程的感知。
本研究从 1966 年 1 月 1 日至 2018 年 4 月 18 日期间，通过 PubMed、Cochrane、Web of Science 和 Scopus 数据库检索相关文献。纳入的研究比较了接受紧急手术和择期手术的患者在知情同意方面的回忆和感知。计算了对并发症和手术细节的回忆、患者满意度、对手术风险信息充分性的感知、报告已阅读书面知情同意书以及影响同意的因素的汇总比值比（OR）。
共纳入 11 项观察性研究（3178 例患者）。与择期手术相比，接受紧急手术的患者对手术并发症（255/504[50.6%]比 321/446[72.0%]；OR，0.29；95%CI，0.11-0.80）的回忆率较低。Meta 分析显示，与择期手术相比，接受紧急手术的患者对知情同意过程的满意度（319/459[69.5%]比 882/1064[82.9%]；OR，0.53；95%CI，0.34-0.83）较低，阅读知情同意书的患者比例（130/395[32.9%]比 424/714[59.4%]；OR，0.35；95%CI，0.27-0.46）较低。接受紧急手术的患者将疼痛、镇痛药物和疲劳列为可能影响同意的因素。
接受紧急手术的患者对知情同意过程和手术并发症的回忆较差。此外，患者报告的满意度较低，且阅读书面知情同意书的患者比例较低，这表明目前的沟通过程存在问题。需要开发有效的工具来改善紧急手术中的知情同意。
