Miller Samuel M, Morton Claire, Glerum Kimberly M, White Erin M, Becher Robert D, Yoo Peter S, Rosenthal Ronnie A, Tinetti Mary E
Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT 06520-8088, USA.
Department of Medicine, Yale School of Medicine, PO Box 208062, New Haven, CT 06520-8088, USA.
Surg Pract Sci. 2023 Aug 1;14:100205. doi: 10.1016/j.sipas.2023.100205. eCollection 2023 Sep.
Over half of surgeries in the United States are performed on older adults. The aims of this study were to quantify geriatric-relevant discussion topics and assessments during the consent process and to assess the need for a structured approach to consent older patients.
General surgery residents at a single institution answered questions about content of the informed consent process and preoperative assessment in adult and geriatric (> 65) patients. Questions addressed frequency of geriatric- relevant discussions, assessments and consultations for the two patient groups.
Part 1 was completed by 66/75 residents (88.0%). Most residents received training in informed consent during medical school or residency (95%). Common avenues for training were direct observation of attending surgeons or senior residents (85%), followed by didactic teaching (47%) and independent reading (30%). Only three residents (two PGY1s and one PGY2) reported receiving specific training in how to achieve informed consent in older patients. Part 2 was completed by 47/56 eligible residents (83.9%). Postoperative expectations (85.1%), living situation (53.2%), postoperative goals (53.2%), and advanced directives (42.6%) were most commonly discussed. Cognitive testing (19.1%), geriatrics consults (14.9%), and frailty scores (4.3%) were rarely addressed. There were no correlations between discussion of this information with resident age, level in residency, self-identified gender, or self-identification as a member of a racial or ethnic minority.
Geriatric-relevant topics and assessments occurred sporadically during the resident-led informed consent process and were more common with senior residents. Training in geriatric relevant informed consent rarely occurs during residency. These results, if generalizable across surgical training sites, highlight the need for a structured curriculum to address geriatric-relevant perioperative concerns.
美国超过一半的手术是针对老年人进行的。本研究的目的是量化在同意过程中与老年医学相关的讨论话题和评估，并评估针对老年患者同意过程采用结构化方法的必要性。
一家机构的普通外科住院医师回答了关于成人和老年（>65岁）患者知情同意过程内容和术前评估的问题。问题涉及两组患者与老年医学相关讨论、评估和咨询的频率。
66/75名住院医师（88.0%）完成了第一部分。大多数住院医师在医学院或住院医师培训期间接受了知情同意方面的培训（95%）。常见的培训途径是直接观察主治医生或高级住院医师（85%），其次是理论教学（47%）和自主阅读（30%）。只有三名住院医师（两名PGY1和一名PGY2）报告接受了关于如何在老年患者中获得知情同意的特定培训。47/56名符合条件的住院医师（83.9%）完成了第二部分。术后期望（85.1%）、生活状况（5,32%）、术后目标（53.2%）和预先指示（42.6%）是最常讨论的内容。认知测试（19.1%）、老年医学咨询（14.9%）和衰弱评分（4.3%）很少被提及。这些信息的讨论与住院医师年龄、住院医师级别、自我认定的性别或自我认定为少数族裔成员之间没有相关性。
在住院医师主导的知情同意过程中，与老年医学相关的话题和评估偶尔出现，且在高级住院医师中更常见。住院医师培训期间很少进行与老年医学相关的知情同意培训。如果这些结果在所有外科培训地点都具有普遍性，那么就凸显了需要一个结构化课程来解决与老年医学相关的围手术期问题。
