title: The leap to trust: perspective of cholecystectomy patients on informed decision making and consent.
abstract: BACKGROUND
  Although experts in ethics and law prescribe autonomous decision making as an essential component of informed consent to operative treatment, patients with esophageal cancer told us in a previous study that they preferred to entrust decision making to their caregivers in the context of life-threatening illness. The purpose of this study was to describe the patients' perspective on the process of informed decision making and consent to operative treatment in the context of a less frightening illness and intervention.
  
  
  METHODS
  Face-to-face interviews with 33 patients recovering from elective cholecystectomy for cholelithiasis were conducted at Toronto General Hospital in Ontario, Canada. The views of patients were analyzed using a qualitative approach.
  
  
  RESULTS
  Patients described a spectrum of initial attitudes toward operative treatment ranging from profound distrust to unquestioning faith. Important factors influencing the decision to accept cholecystectomy included increasingly intolerable symptoms and fear of complications of the disease. Patients managed their doubts and fear by various means, without fully resolving them.
  
  
  CONCLUSIONS
  In the context of symptomatic chronic cholelithiasis, pathways to consent for operative treatment originated at diverse, culturally determined starting points. Patients work their way through the decision process along many paths. Some rely on gathering information, but eventually all set aside unresolved residual doubts and fears, enabling a leap to trust and a decision to act.
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Ontario, Canada.
authors.forename: Martin F
authors.initials: MF
authors.lastname: McKneally
authors.forename: Esther
authors.initials: E
authors.lastname: Ignagni
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Martin
authors.forename: Jason
authors.initials: J
authors.lastname: D'Cruz
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000523:psychology*; D002769:Cholelithiasis / Q000523:psychology* / Q000601:surgery; D003657:Decision Making; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D035502:Trust / Q000523:psychology*