Wouter Leclercq

Chapter 1 14 OUTLINE OF THESIS This thesis presents studies that focus on surgical patient counselling using methods of preoperative surgical informed consent (SIC) and postoperative e-health counselling. Part I Preoperative counselling and surgical informed consent In chapter 2 the aspects of SIC are reviewed. A general introduction of issues related to consent in the medical arena including historical background, evolution and present dilemmas is provided. A number of suggestions possibly improving the SIC process in daily practice are discussed. The current knowledge base, skillset and practice regarding SIC of Dutch general surgeons, orthopaedic surgeons and plastic surgeons are discussed in chapter 3 and 4 . Improvement on all aspects may seem possible, feasible and necessary to improve daily healthcare. Chapter 5 focuses on the patient’s perspective of preoperative education and informed consent in young adults undergoing bariatric surgery. The goal of this study was to improve the SIC process and to develop an informed consent process for adolescents undergoing bariatric surgery. In chapter 6 the quality of the SIC process is analysed after audiotaping consultations. In chapter 7 patient and surgeon questionnaires for Shared Decision Making (SDM) are compared to the medical notes in the electronic patient dossier (EPD). An inadequate SIC process may result in malpractice claims or medical disciplinary board (MDB) complaints. Aim of the study in chapter 8 was to analyse characteristics of a decade of malpractice claims and MDB decisions regarding SIC in the Netherlands. In chapter 9 the currently used SIC forms that are used in Dutch hospitals were analysed for legal adequacy and readability in order to design a best practice SIC form that may aid surgeons and patients in the SIC process. Part II Postoperative counselling and e-health Substitution of usual perioperative care by e-health as a means to enhance postoperative recovery in patients undergoing day care surgery for general surgical or gynaecological procedures is the subject of chapter 10 . Chapter 11-14 provide a summarizing discussion and conclusions, future perspectives, impact paragraph and Dutch summary.