A review of surgical informed consent: past, present, and future. A quest to help patients make better decisions.
BACKGROUND
Informed consent (IC) is a process requiring a competent doctor, adequate transfer of information, and consent of the patient. It is not just a signature on a piece of paper. Current consent processes in surgery are probably outdated and may require major changes to adjust them to modern day legislation. A literature search may provide an opportunity for enhancing the quality of the surgical IC (SIC) process.


METHODS
Relevant English literature obtained from PubMed, Picarta, PsycINFO, and Google between 1993 and 2009 was reviewed.


RESULTS
The body of literature with respect to SIC is slim and of moderate quality. The SIC process is an underestimated part of surgery and neither surgeons nor patients sufficiently realize its importance. Surgeons are not specifically trained and lack the competence to guide patients through a legally correct SIC process. Computerized programs can support the SIC process significantly but are rarely used for this purpose.


CONCLUSIONS
IC should be integrated into our surgical practice. Unfortunately, a big gap exists between the theoretical/legal best practice and the daily practice of IC. An optimally informed patient will have more realistic expectations regarding a surgical procedure and its associated risks. Well-informed patients will be more satisfied and file fewer legal claims. The use of interactive computer-based programs provides opportunities to improve the SIC process.
Leclercq
Wouter K G
WK
Department of General Surgery, Máxima Medical Centre, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands. wleclercq@hotmail.com
Keulers
Bram J
BJ
Scheltinga
Marc R M
MR
Spauwen
Paul H M
PH
van der Wilt
Gert-Jan
GJ
D003657:Decision Making; D006381:Helsinki Declaration; D049673:History, 20th Century; D006801:Humans; D033181:Information Dissemination; D007258:Informed Consent / Q000266:history / Q000331:legislation & jurisprudence / Q000592:standards; D016743:Mental Competency / Q000331:legislation & jurisprudence; D010817:Physician-Patient Relations; D016032:Randomized Controlled Trials as Topic; D013514:Surgical Procedures, Operative; D014342:Truth Disclosure