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      Should patients set the agenda for informed consent? A prospective survey of desire for information and discussion prior to routine cataract surgery

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          To ascertain the level of information relating to specific risks desired by patients prior to cataract surgery.


          Dedicated cataract surgery pre-assessment clinics of 2 hospitals in South West Wales, UK.


          Consecutive patients (106) were recruited prospectively. Of these, 6 were formally excluded due to deafness or disorientation. Eligible patients (100) were asked a set of preliminary questions to determine their understanding of the nature of cataract, risk perception, and level of information felt necessary prior to giving consent. Those who desired further information were guided through a standardized questionnaire, which included an audio-visual presentation giving information relating to each potential surgical complication, allowing patients to rate them for relevance to their giving of informed consent.


          Of the entire group of 100, 32 did not wish to know “anything at all” about risks and would prefer to leave decision making to their ophthalmologist; 22 were interested only in knowing their overall chance of visual improvement; and 46 welcomed a general discussion of possible complications, of whom 25 went on to enquire about specific complications. Of these 25, 18 wished to be informed of posterior capsular (PC) tearing, 17 of endophthalmitis, 16 each of dropped lens, retinal detachment and corneal clouding, and 15 of bleeding, sympathetic ophthalmia, and PC opacification.


          Patients differ in their desire for information prior to cataract surgery, with one significant minority favoring little or no discussion of risk and another wishing detailed consideration of specific risks. A system of consent where patients have a choice as to the level of discussion undertaken may better suit patients’ wishes than a doctor-specified agenda.

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          Most cited references 24

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          Parental desire for perioperative information and informed consent: a two-phase study.

          The purpose of this investigation was to identify the perioperative anesthetic information parents want from the anesthesiologist, and to determine whether the provision of detailed anesthetic risk information is associated with increased parental anxiety. The investigation consisted of a cross-sectional study followed by a randomized controlled trial. In Phase 1, baseline and situational anxiety, coping strategy, and temperament were obtained from parents of children undergoing surgery (n = 334). A questionnaire examining the desire for perioperative information was administered to all parents. In Phase 2, 47 parents were randomly assigned to receive either routine anesthetic risk information (control) or detailed anesthetic risk information (intervention). The effect of the intervention on parental anxiety was assessed over four time points: prior to the intervention, immediately after the intervention, day of surgery in the holding area, and at separation to the operating room. For Phase 1, the majority of parents (> 95%) preferred to have comprehensive information concerning their child's perioperative period, including information about all possible complications. For selected items, increased parental educational level was associated with increased desire for information (P < 0.05). For Phase 2, when the intervention group was compared with the control group, there were no significant differences in parental anxiety over the four time points [F(1,45) = 0.6, P = 0.4]. Also, the interaction between time and group assignment was not significant [F(3,135) = 1.66, P = 0.18]. We conclude that parents of children undergoing surgery desire comprehensive perioperative information. Moreover, when provided with highly detailed anesthetic risk information, the parental anxiety level did not increase.
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            Risk management strategies following analysis of cataract negligence claims.

             ,  ,  Paul H. Goodwin (2005)
            Clinical governance and risk management is very important in today's clinical practice. Cataract surgery is one of the most common procedures performed in the NHS, with around 200,000 operations per year. In order to help minimise the frequency of negligence claims, we performed a collaborative study to analyse claims relating to cataract surgery, dealt with by the defence organisations of England, Scotland, Wales, and Northern Ireland. All claims dealt with by the Medical Defence Union, the Medical Protection Society, and the Medical and Dental Defence Union of Scotland from January 1990 to December 1999, were analysed by three ophthalmologists with at least 5 years' speciality experience. Recurrent themes were identified and claims were grouped by major causative factor. The findings were discussed by a panel compromising the authors in conjunction with the defence unions and risk management strategies were designed. There were 96 claims within the 10- year period analysed. Of these, the largest group (52) pertained to claims that related to accepted complications of cataract surgery. The remainder comprised two groups: 'Medical Errors' (anaesthetic, surgeon, and biometry) and 'Other Claims' comprising subjective complaints, pain and poor visual outcome. A total of 16 claims had been settled by May 2002, 45 are ongoing and 35 have closed without settlement. The majority of claims pertained to well-recognised complications of cataract surgery. If these risks are adequately explained to the patient before surgery and if the care provided reaches a standard acceptable to a responsible body of professional opinion, all such claims should be defensible. Good visual outcome does not protect against litigation.
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              Patients' desire for information about anaesthesia. Scottish and Canadian attitudes.

              Patients in Canada and Scotland were asked to complete a pre-operative questionnaire examining their desire for information relating to anaesthesia. In both Canada and Scotland, patients under the age of 50 years had a greater wish to receive information than those who were older (p less than 0.0001). In Canada, female patients were found to be more keen to receive pre-operative information than males of the same age group (p less than 0.05). The priority given to individual pieces of information was remarkably similar in both countries. Details of dangerous complications of anaesthesia and surgery were consistently rated of low priority, with high priority going to postoperative landmarks such as eating and drinking. Both countries rated meeting the anaesthetist before surgery as the highest priority of all.

                Author and article information

                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                October 2008
                October 2008
                : 4
                : 5
                : 1119-1125
                [1 ]Singleton Hospital, Swansea, UK;
                [2 ]West Wales General Hospital, Carmarthen, UK
                Author notes
                Correspondence: Michael Austin, Department of Ophthalmology, Singleton Hospital, Swansea SA2 8QA, UK, Tel +44 1 792 285 036, Fax +44 1 792 285 839, Email mike.austin@ 123456swansea-tr.wales.nhs.uk
                © 2008 Dove Medical Press Limited. All rights reserved
                Original Research


                informed consent, cataract extraction, patient-centered care


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