Patients' recall of clinical information following laparoscopy for acute abdominal pain

Patient Recall of Informed Consent at 4 Weeks After Total Hip Replacement With Standardized Versus Procedure-Specific Consent Forms

OBJECTIVES

Informed consent plays a pivotal role in the operative process, and surgeons have an ethical and legal obligation to provide patients with information to allow for shared decision-making. Unfortunately, patient recall after the consent process is frequently poor. This study aims to evaluate the effect of procedure-specific consent forms on patient's recall four weeks after total hip replacement (THR).

METHODS

This is a prospective study using a posttest-only control group design. Sixty adult patients undergoing total hip replacement were allocated to be consented using either the generic or the surgery-specific consent form. Four weeks after surgery, a phone interview was conducted to assess patient's recall of risk of surgical complications.

RESULTS

Patient demographic characteristics and educational attainment were similar in both groups. There was a statistically significant increase in the mean number of risks recalled in the study group at 1.43 compared with 0.67 in the control group (P = 0.0131).

CONCLUSIONS

Consent is a complex process, and obtaining informed consent is far from straightforward. A statistically significant improvement in patient's recall with the use of procedure-specific consent forms was identified, and based on this, we would advocate their use. However, overall patient recall in both groups was poor. We believe that improving the quality of informed consent may require the sum of small gains, and the use of procedure-specific consent forms may aid in this regard.

Patient engagement: four case studies that highlight the potential for improved health outcomes and reduced costs

The energy of patients and members of the public worldwide who care about improving health is a huge, but still largely unrecognized and untapped, resource. The aim of patient engagement is to shift the clinical paradigm from determining "what is the matter?" to discovering "what matters to you?" This article presents four case studies from around the world that highlight the proven and potential abilities of increased patient engagement to improve health outcomes and reduce costs, while extending the reach of treatment and diagnostic programs into the community. The cases are an online mental health community in the United Kingdom, a genetic screening program in the United Arab Emirates, a World Health Organization checklist for new mothers, and a hospital-based patient engagement initiative in the United States. Evidence from these and similar endeavors suggests that closer collaboration on the part of patients, families, health care providers, health care systems, and policy makers at multiple levels could help diverse nations provide more effective and population-appropriate health care with fewer resources.

Using the Health Belief Model to explain patient involvement in patient safety

BACKGROUND

With the knowledge that patient safety incidents can significantly impact patients, providers and health-care organizations, greater emphasis on patient involvement as a means to mitigate risks warrants further research.

OBJECTIVE

To understand whether patient perceptions of patient safety play a role in patient involvement in factual and challenging patient safety practices and whether the constructs of the Health Belief Model (HBM) help to explain such perceptions.

DESIGN

Partial least squares (PLS) analysis of survey data.

SETTING AND PARTICIPANTS

Four inpatient units located in two tertiary hospitals in Atlantic Canada. Patients discharged from participating units between November 2010 and January 2011.

INTERVENTION

None.

RESULTS

A total of 217 of the 587 patient surveys were returned for a final response rate of 37.0%. The PLS analysis revealed relationships between patient perceptions of threat and self-efficacy and the performance of factual and challenging patient safety practices, explaining 46 and 42% of the variance, respectively.

DISCUSSION

The results from this study provide evidence for the constructs and relationships set forth by the HBM. Perceptions of patient safety were shown to influence patient likelihood for engaging in selected patient safety practices. While perceptions of barriers and benefits and threats were found to be a contributing factor to patient involvement in patient safety practices, self-efficacy plays an important role as a mediating factor.

CONCLUSIONS

Overall, the use of the HBM within patient safety provides for increased understanding of how such perceptions can be influenced to improve patient engagement in promoting safer health care.

Availability of accessible and high-quality information on the Internet for patients regarding the diagnosis and management of rotator cuff tears

BACKGROUND

In the era of informed patient decision-making, educated patients are vital contributors. The Internet provides a vast information source that patients will access. It is imperative that this information be relevant and understandable. Various treatments, each with advantages and disadvantages, are available. We sought to examine the standard of information about the diagnosis and management of rotator cuff tears available to patients on the Internet.

METHODS

We identified 125 websites from searching "rotator cuff tear" in the 5 most popular Internet search engines. The websites were examined for readability by measuring the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, and the Gunning Fog Index. The quality of the websites was measured by the DISCERN instrument, the Journal of the American Medical Association benchmark criteria, and Health on the Net Foundation certification.

RESULTS

There were 59 individual URLs analyzed. Overall, the quality was poor, with the average DISCERN score being only 39.47. Furthermore, the mean reading grade level was above 9 (recommended level, 6). Health on the Net Foundation certification did correspond to significantly worse readability scores (P = .004) but did not correlate with improved DISCERN scores. Those that satisfied more of the Journal of the American Medical Association benchmark criteria had significantly better DISCERN scores (P < .001).

CONCLUSION

Information about rotator cuff tears is of a low standard and is in many cases written at too high a level for the general population. There are instruments of which we, as surgeons, must be aware to evaluate the resources available and to recommend them to patients to ensure that they understand their condition and treatment options.

Most adults with childhood-onset epilepsy and their parents have incorrect knowledge of the cause 20-30 years later: a population-based study

RATIONALE

Understanding the cause of childhood-onset epilepsy should be important for families and the patient as he/she becomes an adult. We studied the accuracy of information about the cause that adults with childhood-onset epilepsy and their parents reported many years after the initial diagnosis.

METHODS

Patients and parents in the Nova Scotia childhood-onset epilepsy population-based study were contacted. All patients developed epilepsy between 1977 and 1985 with follow-up 20-30 years later with a semistructured telephone interview. Of 600 eligible patients, 373 (62%) answered a question about what they thought had caused the epilepsy.

RESULTS

We identified a cause in 210 of 373 (56%) patients, and no cause was found in 44%. Surprisingly, only 38% of families knew the correct cause. Nearly all had been followed during childhood by a child neurologist, and all adults had a family physician. Responses were concordant in 40% with our causal diagnoses and not concordant in 60%. Responses were divided into 5 categories: (1) In 26%, the family was sure of the cause when no cause had been identified; (2) In 16%, there was a definite known cause, but families did not recall any cause at all; (3) In 18%, we did not identify a cause and neither did the family; (4) In 20%, we identified a definite cause as did the family, but the causes were completely different; and (5) In 20%, we identified a cause, the same one as the family. Correct information did not vary with broad epilepsy syndrome groupings, the presence or absence of intellectual disability, epilepsy remission, parental education, or family income. Those with intractable epilepsy were more likely to be concordant (p=0.002). None of those with Rolandic epilepsy were correct (n=41).

CONCLUSIONS

Most adults with childhood-onset epilepsy and their parents have a strikingly poor recall of the cause. We suggest that families receive this information in a written document that is periodically updated, can be preserved, and can be referred to over time.

Informed consent for emergency surgery--how much do parents truly remember?

BACKGROUND/PURPOSE

The purpose of this study was to evaluate parental retention of possible surgical complications in children undergoing emergency laparoscopic appendectomy.

METHODS

A prospective pilot study involving parents whose children had emergency laparoscopic appendectomy was performed. Parents were counseled regarding 7 potential complications of laparoscopic appendectomy. They were asked to recall this list immediately after the consent process (immediate recall, IR) and before discharge from inpatient stay (delayed recall, DR). A score (0-7) was awarded indicating the number of correct answers. For each recall, parents were also reminded on complications they omitted (prompted recall). One surgeon administered all consents in person. Demographic data were collected. Data were reported as median (range).

RESULTS

Twenty-one mothers and 10 fathers were recruited, aged 42 years (30-54). Nine (29%) had university or post-graduate education. Score for IR was 2 (0-6). Five (16%) parents scored 0. Upon prompting after IR, 20 (65%) parents had no impression of at least 1 complication. Score for DR was 2 (0-7), while 7 (23%) parents scored 0. At prompting after DR, 25 (81%) had no memory of at least one complication. Eight (26%) demonstrated improved DR scores. Scores were not affected by patient demographics or time between interviews.

CONCLUSIONS

There is poor parental retention of information provided during operative consent. Hence, proper documentation of this process is essential.

Patient recall after diagnostic laparoscopy for abdominal pain

BACKGROUND

The purpose of the study was to ascertain how well patients recall their discharge diagnosis and details of their surgical procedure after a diagnostic laparoscopy at our institution.

METHODS

Three hundred and forty-five patients were identified as being eligible in the study. Patient characteristics and treatment details were recorded. They were then contacted by telephone and 258 patients participated (response rate 75%). They were asked the same seven questions by an investigator who was blinded to their treatment details and their responses recorded.

RESULTS

The sample consisted of 248 (96%) women and 10 (4%) men. Only seven persons (3%) were incorrect about the state of their appendix. However, 108 persons (42%) were incorrect about their discharge diagnosis. Seventy-one patients (28%) were unhappy with the information they received while in hospital. Age, whether pathology was found, dissatisfaction or type of operation was not found to significantly influence patient recall of diagnosis.

CONCLUSION

We found that patients having a diagnostic laparoscopy at our institution often leave the hospital dissatisfied and with a poor understanding of their discharge diagnosis. This has important implications for future assessments of acute abdominal pain in these patients and can lead to misinformation and unnecessary surgical procedures.

Impact of the informed consent process on patients’ understanding of varicose veins and their treatment

AIM

It is particularly important that patients have reasonable understanding of the risks, benefits and nature of elective surgery. This study sought to analyse this level of understanding in patients undergoing varicose vein surgery

METHODS

Eighty two patients completed a questionnaire in the vascular outpatient clinic and were asked to complete a telephone questionnaire following the clinic.

RESULTS

Pain (n = 46) was the primary reason patients considered varicose vein surgery followed by appearance (n = 32). Most patients felt that varicose veins placed them at high risk of leg ulcers (n = 46) and DVT (n = 41). A high level of expectation that surgery would significantly affect pain and flares was recorded. While the outpatient visit did not materially change these misconceptions, an educational leaflet significantly enhanced the recall of complications (p = 0.028) in patients who remembered receiving a leaflet.

CONCLUSION

Patients attending varicose vein clinics have an unrealistic expectation of the benefits of surgery and fail to understand the benign nature of their condition. The outpatient process has little effect on patient-held beliefs.