Wouter Leclercq

Chapter 2 32 A number of validated tests have been developed to check the patient’s competence. A recent study demonstrates that the outcome of such a test is almost as consistent as an expert opinion. 28 Examples of such validated tests are the Mini-Mental State Examination, the MacArthur Competence Assessment Tool, the Decision Evaluation Scales (DES), and the MacCaT‑T. 23,28,57 All these tests are suitable for computer-based programs. An effective way of informing patients about their surgical procedure might be by using computer-based information. 23,51,58 The more interactive information is provided, the more a patient remembers (Table 2.1). 11,13,24,34,40,42,58-76 Nonetheless, the amount of information that is transferred during a preoperative consultation in an outpatient environment can be overwhelming. 41 If transfer of information is adjusted to the patient’s own speed and wishes in an interactive setting, he/she tends to comprehend more and will have better recapitulation. 40-42,66 Surprisingly, patients with limited computer experience, a low educational level, or of old age appear to benefit. 40,52,77,78 Validated tests have been developed to check if the patient actually understands the information. 28,57 Using this approach, doctors buy time that can be used for discussing specific procedural details, personal questions, or emotions. Recording the SIC process is of growing importance in medicolegal cases. Computer-based interactive IC programs have the advantage of recording every step a patient takes in gaining information. 35 In various empirical studies the consent form is replaced by a recorded patient authorization through a computer-based interface. 40,42,79 This approach focuses on only the consent part of the process; it does not check whether a patient is competent or understands the information sufficiently. Basically, it is nothing more than a digitized IC form. 40,42 More research is necessary to improve the SIC process in daily practice. We have recently developed a SIC program based on the best available practice as described in this review. This program uses an online interface that can be used at home or at the hospital for patients needing more guidance. In this program, patients are first screened for their competence. Then basic information on their specific surgical procedure is provided through text, audio information, and flash movies. Many words are highlighted (hyperlinked) and can be selected for extra information. Patients can also select other options for extra information on logistic, medical, or legal items. The patient’s level of knowledge is checked at the end of this information part. If insufficient information is retained, these items are repeated because basic information must be trustworthy before the consent part starts. The consent part of SIC provides an overview of the surgical procedure, its risks, and alternatives. The patient or the surgeon can print out the form and both can sign it after all remaining questions are answered. This program will be evaluated on a national level in an upcoming trial and may ideally be integrated into our future practice.