Wouter Leclercq

Chapter 6 96 MATERIALS ANDMETHODS Setting This prospective, observational study was conducted at the plastic surgery outpatient clinics of one academic and two non-academic teaching hospitals in the Netherlands. Audio recordings were made of consultations of patients referred with Dupuytren Disease. The consultations were carried out by plastic surgeons and their residents. The obtained recordings were analyzed after the consultation. The doctor and the patient were the only people present in the consultation room. A digital audio recorder was installed prior to the consultation. Participating doctors and patients were aware that SIC was the subject of the research and that they were being recorded. However, they had no knowledge about what specific content would be analyzed. We obtained written and verbal informed consent from both patients and doctors for participation in this study. The need for ethical approval of this study was waived by the local medical ethics committee. Inclusion in this study was limited to patients that were both presenting with Dupuytren Disease and being counseled for the surgical treatment option of a limited fasciectomy. This treatment usually requires only a single preoperative consultation, in which the entire SIC information exchange takes place. Exclusion criteria were: (1) Consultations that did not directly lead to a scheduling for limited fasciectomy. (2) Consultations with patients who had an earlier healthcare consultation about Dupuytren Disease during the past one-and-a-half years and patients who had a surgical correction for Dupuytren Disease in the past 10 years. (3) Consultations with patients under 18 years of age. (4) Consultations with patients with a language barrier. Analysis The information discussed on the audiotapes was scored on a checklist by one of the investigators (BBB). This checklist contained a range of information items that might be addressed during the process of SIC. The items were sourced from the 2004 report by the Royal Dutch Medical Association (KNMG). This report stipulates how to perform the MTCA in practice. 2 Information items on the list were specified to Dupuytren Disease using the Dutch guidelines on Dupuytren Disease established by the Dutch Society for Plastic Surgery in 2012. 11 The checklist consisted of 33 different information items and divided into the following eight categories: diagnosis, treatment characteristics, purpose, risks, postoperative period, operating surgeon, alternatives, and prognosis. An overview of scored checklist results was made. For every item on the checklist, we calculated the percentage of consultations in which the item was addressed. Per information category, the mean of these percentages was determined.