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Communicating Orthopaedic Surgical Consent
Newswise — Signing a surgical consent form is a common and
required part of the health-care process.
Before undergoing almost any medical
procedure, patients must read and sign a
form stating that they understand the
treatment and agree to have it performed.
However, a study presented today at the 75th Annual Meeting
of the American Academy of Orthopaedic
Surgeons (AAOS), found that few patients
really understand the consent form, even
when a physician, physician’s assistant or
other health-care provider discusses the
form with them in advance.
This lack of comprehension should be a matter of great
concern to patients and physicians who want
to ensure good communication regarding
medical treatment.
“There are a lot of factors preventing patients from fully
comprehending their consent forms,” said
Allison E. Crepeau, MD, primary author of
the study and an orthopaedic resident at the
State University of New York at Stony Brook.
“Age and level of education had a significant effect on
whether the patient understood the form and
remembered the information later. In
addition, the stress of upcoming surgery
will certainly have an effect on a patient’s
comprehension.”
In this study, patients about to undergo elective orthopaedic
surgery were given a consent form by a
physician’s assistant, who also spent 10 to
20 minutes reading the standardized form to
the patient, explaining each aspect of the
form in detail. Immediately following the
discussion, the patients signed the forms.
They were then given a 24-item questionnaire to test their
recall of points specifically detailed on
the consent form.
Below are just a few examples that appeared on the patient
questionnaire:
• A trainee (resident) may be present in my
surgery. True* or False
• A sales representative may participate in
the procedure. True or False*
• In the event that a health-care provider
sustains a needle stick/exposure to my blood
or bodily fluid, they may draw my blood and
test me for;
a. HIV
b. hepatitis*
c. both
d. neither
(correct answers are marked with an *)
These patients answered an average of 71.5 percent of all the
questions correctly.
Patient comprehension of the consent form dropped even
further following surgery.
At the first post-operative visit with the physician
about one to two weeks after surgery,
patients responded to the same questionnaire
again; patients who had a second
post-operative visit, one to two months
after surgery, were given the questionnaire
a third time. Both groups answered only 60
percent of questions correctly.
Age was found to be a huge factor in a patient’s recall, as
patients over the age of 50 answered fewer
questions correctly than the under-50 group.
Education level also appeared to have an effect. For example,
patients with only an eighth-grade education
got the lowest percentage of questions
correct, and that percentage increased as
the level of education increased, with
patients who had graduate degrees answering
the highest percentage correctly.
This trend was most notable on the post-operative scores.
“Informed consent has been shown to be an important
protection for both the patient and the
physician, ensuring that patients undergoing
surgery fully grasp the entire process,”
said Dr. Crepeau.
“Both physicians and patients need to take responsibility by
asking questions and openly communicating to
help ensure a good result.”
Disclosure: Dr. Crepeau and her co-authors received no
compensation for this study.
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