Assessing surgeons' disclosure of risk information before carotid endarterectomy.
BACKGROUND
To make an informed decision about treatment, patients need accurate information about the benefits and risks of treatment and 'non-treatment' options. A survey was conducted to determine patients' recall of the extent and effect of preoperative disclosure by surgeons to patients of risks about carotid endarterectomy (CEA).


METHODS
A self-administered questionnaire was given to 133 patients undergoing elective CEA in New South Wales. The primary outcome measures were patient recall of preoperative discussion, self-assessed estimates of stroke risk with and without surgery and receipt of written information before CEA.


RESULTS
A significantly higher proportion of patients recalled that their surgeon discussed the short-term stroke risk (i.e. within 30 days) if they decided to undergo CEA (86.2%) than if they decided not to have the procedure (76.9%) (P = 0.04). Of those patients who recalled the surgeon discussing their short-term stroke risk with CEA, only 24 (18.0%) were accurately able to quantify this risk. Patients were significantly more likely to recall their surgeon discussing their long-term stroke risk (i.e. within 2 years) if they decided not to have CEA (72.4%) than if they decided to have the CEA (31.5%) (P < 0.0001).


CONCLUSIONS
Patients recalled discussions with their surgeon about short-term stroke risk. Only a minority, however, accurately quantified their postoperative stroke risk. In view of variable patient recall, decision aids could assist.
Middleton
Sandy
S
School of Nursing (NSW), ACU National, Sydney, New South Wales, Australia. sandy.middleton@acu.edu.au
Gattellari
Melina
M
Harris
John P
JP
Ward
Jeanette E
JE
D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications / Q000601:surgery; D002983:Clinical Competence; D003657:Decision Making; D016894:Endarterectomy, Carotid / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D010353:Patient Education as Topic; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014342:Truth Disclosure