Under what conditions do patients want to be informed about their risk of a complication? A vignette study.
BACKGROUND
Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present.


OBJECTIVE
To investigate patients' preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results.


METHODS
Vignettes study.


METHODS
Department of Gastroenterology, Academic Medical Centre, the Netherlands.


METHODS
810 consecutive colonoscopy patients.


METHODS
A home-sent questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed.


METHODS
Wish to be informed and importance of information.


RESULTS
Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients' information preference was also related to age, mood and coping style.


CONCLUSIONS
Difficulty of vignettes.


CONCLUSIONS
Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested.
Janssen
N B A T
NB
Academic Medical Centre/University of Amsterdam, PO Box 22660, 1100 DE Amsterdam.
Oort
F J
FJ
Fockens
P
P
Willems
D L
DL
de Haes
H C J M
HC
Smets
E M A
EM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D010817:Physician-Patient Relations; D011183:Postoperative Complications / Q000523:psychology*; D018570:Risk Assessment / Q000941:ethics / Q000379:methods; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult