Patient perspectives on informed consent for anaesthesia and surgery: American attitudes

Abstract

Background: Principles of informed consent are ethically, morally, and legally grounded in physicians' responsibility to patients. This study examined patient expectations regarding the informed consent during the perioperative process, specifically risk information exchange, preferred method and timing of delivery, and the roles that patient anxiety and understanding might play.

Methods: Five hundred patients seen in our pre-operative clinic were surveyed by written questionnaire. Patients were asked about their level of agreement with a number of statements pertaining to informed consent and their preferences for discussion of types of risks. Anxiety concerns, impact of ability to understand complexities of care, preferences for timing, and method of presentation were assessed.

Results: Four hundred eleven of 500 surveys (82%) were completed. A majority of respondents (92% and 80%, respectively) believed the risk of common but less consequential complications and rare yet severe complications should be discussed. Only 21% agreed that anxiety generated by discussion of risks outweighed benefit and only 6% agreed that discussion of risks should be restricted based on patient inability to appreciate complexities of care. Discussion was preferred on the day of surgery, 1 week before, and 1 month before in 46%, 35%, and 16% of respondents, respectively, and independent of level of anxiety generated by such discussion (P = 0.87). Respondents preferred discussion with their anaesthesia provider alone (44%) or in combination with written information (52%) as compared with written information only (4%) (P < 0.01).

Conclusions: Greater awareness of patient preferences and expectations may result in better information exchange between anaesthesia providers and their patients.