Wouter Leclercq

Chapter 11 184 SIC process was far from optimal. Surgical residents require (more) training to improve awareness and skills in SIC. The use of modern tools including web-based interactive programs is advised in order to enhance the quality of the SIC process. A second questionnaire study that was presented in chapter 4 evaluated similar issues but now in Dutch orthopaedic and plastic surgery practices. Although improved adherence to SIC in these more elective subspecialisms was hypothesized (as compared to general surgeons), orthopaedic and plastic surgeons also demonstrated poor knowledge, skills and suboptimal practice regarding SIC. It was concluded that more elective and patient orientated surgical subspecialisms do not necessarily perform better regarding the elements of SIC. There is also an urgent need to optimize SIC management in the orthopaedic and plastic surgery arena. In chapter 5, the preoperative education and informed consent process regarding bariatric surgery in young adults were explored with an emphasis on patient perspective. Young adults (18-25 years) who underwent bariatric surgery more than half a year previously at our centre participated in a semi-structured interview. The results indicated that they were able to recall all consent domains. In contrast, just a portion remembered all of the potential surgical complications. They judged that the current preoperative education mainly focused on positive results, whereas untoward effects were discussed inadequately. The study results clearly indicate that preoperative education including possible scenarios that address surgical risks and lifetime consequences should be improved to help young bariatric patients in making a more well-informed decision. The study in chapter 6 aimed to obtain insight into the current practice of SIC in the Netherlands by audio recording outpatient consultations for Dupuytren disease. Written documentation of the SIC process in the patient’s chart was compared to the recorded informing process that was scored using a checklist. Despite the finding that a relatively large part of the consultation time was spent on SIC, patients received scarce information concerning treatment risks, the postoperative period or the identity of their operating surgeon. Substantial discrepancies in information were observed between the written documentation of SIC and the audio recordings. The use of pre-made lists of ‘discussed information’ in the EPD had a negative impact on the real world discussion emphasizing the need for adequate testing tools before standard incorporation in clinical practice. The lack of generally accepted and clinically relevant outcome parameters in SIC research is a major drawback that influenced all projects in this thesis. Aim of the study in chapter 7 therefore was to test characteristics of a shared decision making (SDM) questionnaire for the purpose of SIC research. The results indicated that a clear imbalance