Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO.
Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
J Am Coll Surg. 2020 Jun;230(6):1025-1033.e1. doi: 10.1016/j.jamcollsurg.2020.02.049. Epub 2020 Apr 3.
The objective of this study was to determine the effects of using the Surgical Risk Preoperative Assessment System (SURPAS) on patient satisfaction and surgeon efficiency in the surgical informed consent process, as compared to surgeons' "usual" consent process.
Patient perception of the consent process was assessed via survey in 2 cohorts: 10 surgeons in different specialties used their "usual" consent process for 10 patients; these surgeons were then taught to use SURPAS, and they used it during the informed consent process of 10 additional patients. The data were compared using Fisher's exact test and the Cochran-Mantel-Haenszel test.
One hundred patients underwent the "usual" consent process (USUAL), and 93 underwent SURPAS-guided consent (SURPAS). Eighty-two percent of SURPAS were "very satisfied" and 18% were "satisfied" with risk discussion vs 16% and 72% of USUAL, respectively. Of those who used SURPAS, 75.3% reported the risk discussion made them "more comfortable" with surgery vs 19% of USUAL, and 90.3% of SURPAS users reported "somewhat" or "greatly decreased" anxiety vs 20% of USUAL. All p values were <0.0001. Among SURPAS patients, 97.9% reported "enough time spent discussing risks" vs 72.0% of USUAL patients.
The SURPAS tool improved the informed consent process for patients compared with the "usual" consent process, in terms of patient satisfaction, ie making patients feel more comfortable and less anxious about their impending operations. Providers should consider integrating the SURPAS tool into their preoperative consent process.
本研究旨在比较使用外科风险术前评估系统（SURPAS）与外科医生的“常规”知情同意过程，评估其对患者满意度和外科医生效率的影响。
通过问卷调查评估患者对知情同意过程的看法，共纳入 2 个队列：10 名不同专业的外科医生使用“常规”同意程序对 10 名患者进行手术，然后对这些医生进行 SURPAS 培训，并在另外 10 名患者的知情同意过程中使用 SURPAS。使用 Fisher 确切检验和 Cochran-Mantel-Haenszel 检验对数据进行比较。
100 名患者接受了“常规”同意程序（USUAL），93 名患者接受了 SURPAS 指导的同意程序（SURPAS）。82%的 SURPAS 患者对风险讨论非常满意，18%的患者表示满意，而 UASUAL 组的这一比例分别为 16%和 72%。在使用 SURPAS 的患者中，75.3%的患者表示风险讨论使他们对手术“更放心”，而 UASUAL 组的这一比例为 19%，90.3%的 SURPAS 患者报告“稍有”或“大大降低”焦虑，而 UASUAL 组的这一比例为 20%。所有 p 值均<0.0001。在 SURPAS 患者中，97.9%的患者报告“有足够的时间讨论风险”，而 UASUAL 患者的这一比例为 72.0%。
与“常规”同意程序相比，SURPAS 工具在提高患者知情同意过程的满意度方面有一定优势，可使患者对即将进行的手术感到更舒适、焦虑程度更低。医务人员应考虑将 SURPAS 工具整合到术前同意过程中。
