Consent In Forefoot Surgery; What Does It Mean To The Patient?

Consent In Forefoot Surgery; What Does It Mean To The Patient?
Leo D. Baxendale-Smith, Scott D. Middleton, John C. McKinley, Colin E. Thomson
The Foot, 25 September 2020
Abstract
Aims
This study aimed to assess patient risk recall and find risk thresholds for patients undergoing elective forefoot procedures.
Methods
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.
Results
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 X’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.
Conclusions
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.

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