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Eur J Cardiothorac Surg 2005;28:910-911
© 2005 Elsevier Science NL

Letter to the Editor

Detailed preoperative information—cruelty or improving quality of informed consent

Department of Cardiothoracic Surgery, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, UK

Received 22 August 2005; accepted 13 September 2005.

^_* Tel.: +44 141 564 5206/211 4731; fax: +44 141 211 4845. (Email: mishrapk_25{at}yahoo.com).

Key Words: Consent • Cardiac • Information • Questionnaire

I read with interest the recent article by Ivarsson and colleagues [1]. It reinforces a growing perception that detailed preoperative information does not increase patient's anxiety and can improve the quality of informed consent. In contrast, some researchers believed that fully informed consent is not only a major obstacle to randomised clinical trials but also unnecessarily cruel to patients [2]. I would like to add a few comments on this article.

Level of risk disclosure varies widely between individual surgeons [3]. Besides, the interpretation of the information provided varies a lot depending on factors like patient's age, educational attainment and intelligence. The authors have used a self-administered questionnaire which is not always the best method to gain information on largely subjective measures like ‘patient's experience of information regarding possible complications’. Face-to-face interviews will give more reliable information in such studies and have several advantages like elimination of interference, elimination of possible influence of other's opinion, certainty about the identity of the respondent and reduction in the number of questions omitted by the respondent. In a self-administered questionnaire, the subject can have difficulties in understanding the questions due to factors such as poor grasp of language, problems in concentration, limited intelligence, etc. In face-to-face interviews, the interviewer can rephrase a question in a manner in which the subject understands it better. Of course, face-to-face interviews are time-consuming, and interviewers need to be trained so that they ask the same question to each subject in the same way. The attributes and attitudes of the interviewer may also influence the response given. Addition of a validation process (i.e. test for interobserver reliability) by using four to five different interviewers and showing a good correlation between them (Spearman's rank correlation coefficient) addresses the last mentioned issue. In spite of the obvious logistic problems associated with arranging face-to-face interviews, there is little doubt that it is a much more robust technique.

The authors have not commented as to when the patient's were consented for surgery. It has been shown that patients are at the most informed immediately after signing the consent form [4]. It will definitely affect patient's response to self-administered questionnaire.

The demographic data which authors have used are not sufficiently good to measure intelligence. A more objective measure like National Adult Reading Test (NART) [5] should be used especially when dealing with older persons as it is reliable even in dementia. Authors have checked the questionnaire for content validity, but it was not tested for construct validity. The IQ scores predicted by NART would have been useful in this regard.

A non-randomised study design and a small pilot study (only five patients) take the shine out of an otherwise well-written paper. A moderately large pilot study helps to smoothen the rough edges of such self-administered questionnaires.

References

1. Ivarsson B, Larsson S, Luhrs C, Sjoberg T. Extended written pre-operative information about possible complications at cardiac surgery—do the patients want to know?. Eur J Cardiothorac Surg 2005;28:407-414.[Abstract/Free Full Text]
2. Tobias, Jeffrey S, Souhami, Robert L. Fully informed consent can be needlessly cruel. Br Med J 1993;6913:1199-1201.
3. McManus PL, Wheatley KE. Consent and complications: risk disclosure varies widely between individual surgeons. Ann R Coll Surg Eng 2003;85:79-82.[Medline]
4. Lavelle-Jones C, Byrne DJ, Rice P, Cuschieri A. Factors affecting quality of informed consent. Br Med J 1993;306(6882):885-890.
5. Nelson HE. National Adult Reading Test (NART). NFER-Nelson; 1982..

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pankaj Kumar Mishra Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mishra, P. K. Search for Related Content PubMed PubMed Citation Articles by Mishra, P. K. Related Collections Education Professional affairs