Wouter Leclercq

A review of surgical informed consent: Past, present, and future. A quest to help patients make better decisions 21 2 INTRODUCTION Daily surgical practice is characterized by an increased complexity of the operative procedures while time pressure on the outpatient staff continues to increase. Moreover, a patient today tends to demand more extensive information from his/her doctors. Execution of these complicated processes must be legally sound. One way to cope with these developments is to optimize patient education in daily practice through computer- based techniques. A next step is to expand the focus from patient education to surgical informed consent (SIC). This overview provides a descriptive study of this challenging field of surgical practice. Informed consent (IC) is a legal term that is supported by jurisdiction and international laws and is described as ‘‘voluntary authorization, by a patient or research subject, with full comprehension of the risks involved, for diagnostic or investigative procedures, and for medical and surgical treatment’’ (year introduced: 1973 (1971), http://www. ncbi. nlm.nih.gov/mesh/68007258? ordinalpos=1&itool= Entrez System2.PEntrez.Mesh.Mesh_ ResultsPanel.Mesh_ RVDoc Sum). Basic elements of IC are ‘‘preconditions,’’ ‘‘information,’’ and ‘‘consent.’’ Preconditions for proper IC include the patient’s competence and voluntariness. The information provided must be adequate and comprehensible. The consent of a patient authorizes the (surgical) procedure that will be performed. The system of the patient giving consent for an invasive procedure or operation (surgical IC or SIC) has been common practice for many years. Providing appropriate preoperative information to a surgical patient is dictated by law and may prevent litigation. In spite of major developments in the law, information technology, and patients wishes, procedural aspects of SIC have not changed sufficiently over the last few decades in most hospitals. Surgeons prepare their patients randomly, and the quality of information will probably differ extensively. Patients are supposed to give SIC with (or without) written information. Currently, patient education and patient-oriented care are important topics. Nevertheless, the literature on the quality of SIC is scarce. The initial concepts and laws on SIC are outdated and have been replaced by up-to-date legislation. Our hypothesis is that daily practice is still based on old habits and therefore is not as good as necessary to meet current needs. The aim of this review was to describe the pertinent literature concerning SIC and to provide suggestions to improve the SIC process in daily practice.