Baxendale-Smith Leo D, Middleton Scott D, McKinley John C, Thomson Colin E
The University of Edinburgh Medical School, 47 Little France Crescent, Edinburgh EH16 4TJ, Scotland, United Kingdom.
Department of Orthopaedics - Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom.
Foot (Edinb). 2020 Dec;45:101741. doi: 10.1016/j.foot.2020.101741. Epub 2020 Sep 25.
This study aimed to assess patient risk recall and find risk thresholds for patients undergoing elective forefoot procedures.
Patients were interviewed in the pre-assessment clinic (PAC) or on day of surgery (DOS); some in both settings. A standardised questionnaire was used for all interviews, regardless of setting. Patients were tested on which risks they recalled from their consent process, asked for thresholds for five pre-chosen risks and asked about a sham risk.
Across all interviews, risk recall on DOS (2.34 risks/patient interview) was significantly lower (p=.05) than in PAC (2.95 risks/patient interview) - this was repeated when comparing results from patients interviewed in both settings only with PAC mean recall of 2.93 risks/patient interview and DOS mean recall of 2.57 risks/patient interview. The mean reported risk thresholds greatly exceeded NHS Lothian's observed complication rates for forefoot procedures. The five risks tested for thresholds produced the same order in each interview setting, suggesting a patient-perceived severity ranking. Patients answering the sham risk question incorrectly tended to recall fewer risks across all interviews.
This study shows that patient risk recall is poor, as previous literature outlines, reinforcing that consent process improvements could be made. It also illustrates the value of PAC visits in patient education, as shown by higher levels of recall when compared to DOS.
本研究旨在评估患者对风险的回忆情况，并找出接受择期前足手术患者的风险阈值。
在术前评估门诊（PAC）或手术当天（DOS）对患者进行访谈；部分患者在两种情况下均接受访谈。无论在何种情况下，所有访谈均使用标准化问卷。测试患者从同意过程中回忆起的风险、询问五个预先选定风险的阈值，并询问一个虚假风险。
在所有访谈中，手术当天（DOS）的风险回忆（每位患者访谈回忆2.34个风险）显著低于术前评估门诊（PAC）（每位患者访谈回忆2.95个风险）（p = 0.05）——仅比较在两种情况下均接受访谈的患者结果时，重复出现这种情况，术前评估门诊平均回忆每位患者访谈2.93个风险，手术当天平均回忆每位患者访谈2.57个风险。报告的平均风险阈值大大超过了NHS Lothian观察到的前足手术并发症发生率。在每个访谈环境中，针对阈值测试的五个风险产生的顺序相同，表明存在患者感知的严重程度排名。回答虚假风险问题错误的患者在所有访谈中往往回忆起的风险较少。
本研究表明，正如先前文献所述，患者对风险的回忆较差，这进一步说明可以改进同意过程。研究还说明了术前评估门诊访视在患者教育中的价值，与手术当天相比，回忆水平更高即证明了这一点。
