Wouter Leclercq

A survey of the current practice of the informed consent process in general surgery in the Netherlands 47 3 SIC in daily practice More than two-thirds (68%) of all respondents did not realize that they are obliged to inform their patients on SIC and patient rights (Question 14). Responses varied widely regarding who is in charge of providing patients with this information (Question 15). Some judged the surgeon responsible (S 42% vs. R 29%, P=0.01), whereas others thought the resident (S 24% vs. R 36%, P=0.004) or the nursing staff (S 9% vs. R 3%, P=0.01) were responsible. Some were convinced leaflets would suffice (S 12% vs. R 5%, P=0.01). By Dutch law, a SIC is required for elective and emergency surgical procedures. Almost half (49%) of the respondents indeed followed this regimen, whereas the other half ignored this requirement (Table 3.2). The latter half obtained SIC only for elective procedures (28%) or decided whether a SIC was necessary on an individual basis (23%). Elements of SIC 1. Assessment of preconditions The first step in the SIC process is checking the patient’s competence on making an informed decision regarding his/her own body and whether this decision is made freely. The respondents almost always (98%) judged these issues on the basis of a personal impression. In contrast, questionnaires or other validated tools were hardly used (1%; Table 3.2). 2. Provision of information The vast majority (98%) provided various specifics on diagnosis and surgical procedure. Surgeons performed better on discussing alternative treatment options compared to residents (S 89% vs. R 80%, P=0.017). Surprisingly, 39% claimed that there was no institutional standard on quality and quantity of information that was deemed necessary to communicate to a patient in the preoperative stage (Table 3.2). Another important issue is the disclosure of potential risks and complications. Surgeons were more often aware of the department’s general agreement on complication rates to be used compared to residents (S 58%, R 40%, P<0.001, Table 3.2). Most respondents used a 1% or 5% complication incidence cut-off point for informing patients (34% or 51%, respectively, Question 13). If a complication was considered serious, respondents were more willing to discuss this untoward event with their patients (S 81%, R 74%, P=0.062, Question 13). Overall, surgeons used specific complication rates more frequently compared to residents. Sources were literature based (S 73%, R 56%, P<0.001), department-specific (S 35%, R 17%, P<0.001) or based on individual results (S 23%, R 3%, P<0.001) (Table 3.2).