Wouter Leclercq

Chapter 4 66 SIC in daily practice Only 37% of the respondents informed their patients on the SIC process itself (Q14). 40 % considered the surgeon responsible for informing patients on SIC. The role for residents regarding this task was considered significantly different by surgeons as compared to residents (R 43% vs. S 17%, P<0.0001, not in table). Very few respondents relied on nursing staff or leaflets as a means to inform patients on SIC (Q18). From a legal standpoint, patients have to give consent to any invasive or operative procedure. Just 37% of the respondents always asked for consent whereas the remaining did not. 31% asked for consent only in elective cases and 32% only in cases where consent was deemed crucial by the doctor (Q5). Elements of SIC Assessment of preconditions Almost all respondents (98%) checked patient competence. However, very few used questionnaires or checklists (3%), so the majority relied on their own judgment (95%) (Q7). Provision of information Sixty-six percent of the respondents claimed to have a standard operating procedure (SOP) regarding specifics of standard information that was communicated to the patient in the preoperative situation (Q8). There was a high consistency regarding the information given to the patients on diagnosis (99%), operative procedure (97%) and complications (98%). There was no difference between OS and PS in informing their patients about alternative treatment options (OS 89%, PS 89%, ns). However, significantly more surgeons (92%) claimed to inform their patients about alternatives compared to residents (80%, P<0.005, not in table) (Q10). An SOP regarding communication of potential complications associated with the procedure was significantly more present in the OS group compared to the PS group (OS 60% vs. PS 44%, P<0.01, not in table). Surgeons were more aware of having a SOP on complication information than residents (S 59% vs. R 44%, P<0.025, not in table) (Q13). One of three respondents (34%) never specified the incidence of a complication, whereas 66 % used complication rates from the literature. 31% of the surgeons used department rates, and 18% also provided personal complication rates. Compared to surgeons, residents were far less likely to provide complication rates from their departments (S 31% vs. R 21%, P=0.04) or personal rates (S 18% vs. R 1%, P<0.001, not in table).