Systematic Review of Preoperative Risk Discussion in Practice

Davis M Aasen; Brett M Wiesen; Abhinav B Singh; Christi Piper; Ben Harnke; Allan V Prochazka; Aaron S Fink; Karl E Hammermeister; Robert A Meguid

doi:10.1016/j.jsurg.2020.02.008

Systematic Review of Preoperative Risk Discussion in Practice

J Surg Educ. 2020 Jul-Aug;77(4):911-920. doi: 10.1016/j.jsurg.2020.02.008. Epub 2020 Mar 16.

Authors

Davis M Aasen¹, Brett M Wiesen¹, Abhinav B Singh¹, Christi Piper², Ben Harnke², Allan V Prochazka³, Aaron S Fink⁴, Karl E Hammermeister⁵, Robert A Meguid⁶

Affiliations

¹ Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
² Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
³ Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
⁴ Professor Emeritus of Surgery, Emory University School of Medicine, Atlanta, Georgia.
⁵ Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Collaborative for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
⁶ Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Collaborative for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: Robert.Meguid@cuanschutz.edu.

PMID: 32192884
DOI: 10.1016/j.jsurg.2020.02.008

Abstract

Background: Informed consent is an ethical imperative of surgical practice. This requires effective communication of procedural risks to patients and is learned during residency. No systematic review has yet examined current risk disclosure. This systematic review aims to use existing published information to assess preoperative provision of risk information by surgeons.

Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a guide, a standardized search in Ovid MEDLINE, Embase, CINHAL, and PubMed was performed. Three reviewers performed the study screening, with 2-reviewer consensus required at each stage. Studies containing objective information concerning preoperative risk provision in adult surgical patients were selected for inclusion. Studies exclusively addressing interventions for pediatric patients or trauma were excluded, as were studies addressing risks of anesthesia.

Results: The initial search returned 12,988 papers after deduplication, 33 of which met inclusion criteria. These studies primarily evaluated consent through surveys of providers, record reviews and consent recordings. The most ubiquitous finding of all study types was high levels of intra-surgeon variation in what risk information is provided to patients preoperatively. Studies recording consents found the lowest rates of risk disclosure. Studies using multiple forms of investigation corroborated this, finding disparity between verbally provided information vs chart documentation.

Conclusions: The wide variance in what information is provided to patients preoperatively inhibits the realization of the ethical and practical components of informed consent. The findings of this review indicate that significant opportunities exist for practice improvement. Future development of surgical communication tools and techniques should emphasize standardizing what risks are shared with patients.

Keywords: communication; informed consent; risk; risk assessment; surgery.

Publication types

Systematic Review

MeSH terms

Adult
Child
Humans
Informed Consent*
Research Design
Surgeons*