Putting risks into words
Subtitle: how surgeons and patients discuss risk.
Published: 2005
Language: eng
Number of pages: 235
Subjects: Surgery -- Risk factors.; Physician and patient.
Description: The purpose of the study is to explore how risks are discussed during surgical consultations by examining three components of that process: risk disclosure, surgeon-patient understanding and emotional concerns.The differentiating factor in this research, which has not previously been evaluated, was the examination of risk discussion over multiple visits of the consultation. It was found that the content of the first and subsequent visits were quite different. Studies focusing on risk disclosure and emotional concerns may find more content in the first visits, whereas studies focused on patient understanding will need to study first and subsequent visits.Methods. Interviews between 5 surgeons and 148 patients were recorded and later transcribed until a decision was made, sometimes requiring multiple visits. There were four medical conditions, Abdominal Aortic Aneurysm, Carotid Stenosis, Peripheral Arterial Disease and Varicose Veins.Results. Surgeons do not discuss risks 27% of the time. The surgeons do not elicit the patients' understanding 78% of the time. Patients did not display understanding of risks, 63% of the time. Patients express concerns 70% of the time across all conditions and surgeons respond positively to emotional concerns expressed by the patients' 91% of the time.Conclusions. This study illustrates a significant gap between theory and practice of informed decision-making. The results are concerning especially since the conditions examined were some of the most serious conditions and surgeries possible and although informed consent criteria for risk discussion, elicitation of understanding and patient understanding were higher for the most serious conditions (Aneurysm and Carotid Stenosis) and when recommending surgery. They did not meet the legal criteria to be a sufficient informed consent process.Despite these gaps, it was also found that the surgeons responded well to patients concerns. Patients expressed more concerns when the condition was more serious but interestingly expressed fewer concerns when surgery was recommended.Over 70% of the time risk disclosure occurred during the first visit of multiple visits. Patient concerns also occurred more frequently during the first visit. Patients displayed their understanding of risks approximately 50% of the time during the second or subsequent visits.
Notes: Thesis (Ed.D.)--University of Toronto, 2005.

Electronic version licensed for access by U. of T. users.

Source: Dissertation Abstracts International, Volume: 66-06, Section: B, page: 3051.