Tuesday, April 13, 2010

Electronically Tailoring Consents

What would you rather know when undergoing a surgical procedure, what are your most likely complications during the proposed surgery based on your own personal characteristics, or all of the potential complications that could arise with your upcoming surgical procedure?

Several major medical centers are betting you'd like to know your tailored personal risks:
Integris Heart Hospital doctors are testing a high-tech consent form for patients considering angioplasty. A computer program draws from a database of 600,000 patients around the country to better predict individual risks and benefits of the procedure.

The new process replaces one-size-fits-all forms that were used primarily as a legal formality. The high-tech version uses simple language and illustrations to explain procedures, while mathematically predicting the risk of complications based on individual characteristics.
While it is impossible to know all of the risks that can occur during a surgical procedure, there may be some value prioritizing risks for a patient based on their renal or hepatic function, for instance. Still, I wonder if we risk sugar-coating invasive procedures (like a coronary angiogram) by suggesting to patients that their risk of stroke was virtually zero.

After all, if you have a stroke during the procedure (no matter how low the pre-operative risk assessment was), your risk suddenly becomes 100%.



Elaine Schattner, M.D. said...

This is interesting, but I'm not sure that more details are better when it comes to explaining operative risk.

Around 20 years ago a physician-relative needed an open lung biopsy. A surgical resident approached us in the pre-op area, consent form in hand.

"You're a doctor," he said. "You know about surgery. Basically anything can happen. Please sign here."

That consent was the opposite of tailored (loose?). It was perhaps the most accurate and least helpful informed consent discussion I've ever witnessed.

Anonymous said...

Majority of them don't still understand the risks involved. One way to get a sense of how well they understood is give them a test on recall, bet that 80% will flunk. Has anyone ever checked to see patients actually understand the risks? Is it upto the doctor to assume they "got it" without any check system?

Anonymous said...

I would like both types of information before undergoing a procedure. Failing to mention potential but rare complications would leave me unprepared, but indicating which complications I'm at highest risk for provides additional useful information. I'm one of those people who wants as much information as I can get.

Anonymous said...

Tailoring for each patient may be helpful; that coupled with stats for the provider would be better yet. As someone who recently had major surgery and was quoted a 25% chance of no improvement or worsening in my condition, I was more concerned about the complications which my surgeon had actually seen/encountered in his practice. (I read the literature and knew the risks in general. It was helpful to know that he personally had never had one major complication that I'd read about).
When my father had CABG it was reassuring to know the surgeon's own personal mortality data was better than the national average.

But in general, agree w/ Anon that most patients don't understand the risks of procedures.