Quality of informed consent for invasive procedures.
OBJECTIVE
To assess quality of informed consent among patients undergoing procedures and patient's preferences about decision-making.


METHODS
Cross-sectional survey of hospitalized patients about informed consent before surgery or other procedures. Preference for decision-making was elicited in hospitalized and ambulatory patients.


METHODS
Large academic general hospital and 10 general clinics, over the years 2002-04.


METHODS
Data of initial survey were presented at staff meetings, recommending asking patients to restate what was explained to them.


METHODS
Rate of patient's recall for explanations on risks and alternative options; rate of patients preferring shared, autonomous and paternalistic modes of decision-making; degree of satisfaction from the decision-making.


RESULTS
Half of the patients did not recall receiving explanations about risks and two-third did not remember discussion of alternative options. The intervention failed, <10% of patients being asked to re-state what was explained to them. Expectations about decision varied: approximately 60% favored shared decision, nearly 20% preferred autonomous decision and the remainder wanted physicians to make decisions. Satisfaction was rated as good or very good by 80% of patients.


CONCLUSIONS
Most patients do not remember receiving explanations about risks or alternatives for procedures, and physicians resist attempts to improve informed consent. Tools should be developed to measure the quality of consent. Since patients significantly differ in their preferred mode of decision-making, the informed consent should be patient-specific.
Brezis
Mayer
M
Center for Clinical Quality and Safety, Hadassah Hebrew University Medical Center, 91120 Jerusalem, Israel. brezis@vms.huji.ac.il
Israel
Sarah
S
Weinstein-Birenshtock
Avital
A
Pogoda
Pnina
P
Sharon
Ayelet
A
Tauber
Renana
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D007557:Israel; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D011786:Quality Control; D013514:Surgical Procedures, Operative / Q000379:methods*; D055815:Young Adult