Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
Children's Hospital Los Angeles, University of Southern California School of Medicine, Division of Plastic Surgery, Los Angeles, CA.
Aesthet Surg J. 2021 Mar 12;41(4):NP162-NP176. doi: 10.1093/asj/sjaa341.
What constitutes adequate information for decision-making and informed consent is a practical question appropriately answered with deference to expertise.
The aims of this study were: (1) to establish consensus on a procedure-specific core information set of essential informed consent information by relevant medical experts for primary breast augmentation surgery; and (2) to define from the clinical perspective the data source and imminence elements of evidence-based risk communication.
The study followed a modified Delphi expert consensus model. Active members of The Aesthetic Society were identified as the relevant clinician experts and were recruited by email. Survey round 1 was informed by a scoping review of the relevant scientific and gray literature. Round 2 was informed by the initial survey round. Consensus was defined a priori as a 75% majority rating.
Expert consensus of essential information was achieved for 16 risk items, 1 risk factor, and 8 expectations-including benefits and burdens-along with clarification of clinically appropriate options to present to all patients considering primary implant-based breast augmentation surgery. A basic, procedure-specific, structure for evidence-based risk data is also described.
This paper reports results for the first phase of a larger pilot study aiming to develop a patient decision aid to replace traditional informed consent documents for the specified procedure. Implications for practice are encouraging in terms of reducing unwanted variation in disclosure practices and information overload.
决策和知情同意所需的充分信息是什么,这是一个实际问题,应尊重专业知识来适当地回答。
本研究的目的是:(1) 通过相关医学专家为原发性乳房隆乳术确立特定手术的核心信息集,以确定基本知情同意信息;(2) 从临床角度定义基于证据的风险沟通的数据源和紧迫性要素。
该研究采用改良 Delphi 专家共识模型。通过对相关科学和灰色文献进行范围审查,确定了审美学会的活跃成员作为相关临床专家,并通过电子邮件招募了他们。第一轮调查由初始调查轮次提供信息。共识被定义为 75%的多数票。
就 16 项风险项目、1 项风险因素和 8 项预期(包括利益和负担)达成了基本信息的专家共识,同时还明确了为考虑进行原发性植入物乳房隆乳术的所有患者提供临床适当选择的方法。还描述了一个基本的、特定于手术的、基于证据的风险数据结构。
本文报告了一项更大的试点研究第一阶段的结果,该研究旨在为特定手术开发患者决策辅助工具,以替代传统的知情同意文件。就减少披露实践中的不必要差异和信息过载而言,对实践具有积极意义。