Informed Consent in Neurosurgery: Patients' Recall of Preoperative Discussion

Summary

¶ Objective. Informed consent (IC) is an important principle of modern medicine and the quality of the process is likely to receive increasing attention in future due to complex surgical procedures and a development of social mistrust for medical treatment. Medico-legal action is also becoming an important influence on IC, in particular the extent of warning to be given about the degree of risk. Evaluation of IC, however, encounters various problems. One key element of a knowledgeable decision is an analysis based on the disclosed risks.

Methods. In a prospective study, 104 consecutive patients were asked to write down as many items of the list of risks as possible two hours after consent interview. The sample included adults (mean age: 52 years) without any significant neuropsychological impairment who underwent elective intracranial (52%) or spinal (48%) surgery. Consent interview based on the proposals of the Deutsche Gesellschaft für Neurochirurgie and the Berufsverband Deutscher Neurochirurgen 1998. The average number of disclosed risks was 32 in intracranial and 25 in spinal surgery. According to the results in the literature 6 ‘typical major risks’ of the proposed treatment were selected.

Results. The median value of the total of recalled risks was 4 in the spinal group and 5 in the intracranial group. The mean score of general information retention was 18%. 65% of the patients did not recall more than 2 of 6 ‘typical major risks’. No significant correlation between recall performance and age or education was found.

Conclusion. The general principles of memory apply and have implications in states of emotional arousal. Whereas education and age, unlike in previous reports, did not appear to influence recall, thus indicating that we had succeeded in tailoring IC to the individual, recall rate was low in most cases. Physicians should highlight the discrepancy and conflict between the requirements for the defence of medical practice in the law courts and the actual interests of patients. They should promote research to establish what really is ‘appropriately informed consent’.