title: [Informed Treatment Consent and Refusal in Advanced Endonasal Surgery: The Ethical Dilemma of Olfaction Sacrifice in Surgery for Chronic Rhinosinusitis with Polyposis].
abstract: BACKGROUND
  Olfaction is frequently affected in chronic rhino-sinusitis with polyposis and has been recognised to have important impact on quality of life. Surgical resolution on cases of maximal medical therapy failure is an option to relieve symptoms, with debates as to how extensive surgery should be. A more radical approach will achieve better disease control with less relapse, but can also compromise olfaction. This decision about a more radical surgical approach should be shared with the patient. Thorough informed consent regarding disease control and hyposmia should be taken.
  
  
  METHODS
  Literature review and consultation with a board of experts.
  
  
  CONCLUSIONS
  We propose some elements to be included in the informed consent discussion, in order to broadly address the surgical limitations regarding anosmia as a frequent complaint, as well as the different options and their associated consequences.
  
  
  CONCLUSIONS
  Radical surgery decision making should be shared with the patient and the informed consent should be as thorough as possible regarding disease control and hyposmia resolution.
authors.affiliation: Serviço de Otorrinolaringologia. Hospital Cuf Descobertas. Lisboa. Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Subtil
authors.affiliation: Serviço de Otorrinolaringologia. Hospital Cuf Descobertas. Lisboa. Portugal.
authors.forename: João Pedro
authors.initials: JP
authors.lastname: Araújo
authors.affiliation: Serviço de Otorrinolaringologia. Hospital Cuf Descobertas. Lisboa. Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Saraiva
authors.affiliation: Serviço de Otorrinolaringologia. Hospital Cuf Descobertas. Lisboa. Portugal.
authors.forename: Alberto
authors.initials: A
authors.lastname: Santos
authors.affiliation: Serviço de Otorrinolaringologia. Hospital Cuf Infante Santo. Lisboa. Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Vera-Cruz
authors.affiliation: Serviço de Otorrinolaringologia. Hospital Cuf Infante Santo. Lisboa. Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Paço
authors.affiliation: Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa. Portugal.
authors.forename: Diogo
authors.initials: D
authors.lastname: Pais
mesh_terms: D006801:Humans; D007258:Informed Consent; D009298:Nasal Polyps / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D000857:Olfaction Disorders / Q000209:etiology*; D011788:Quality of Life; D012852:Sinusitis / Q000601:surgery*; D012903:Smell; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D016312:Treatment Refusal