Informed consent: do information pamphlets improve post-operative risk-recall in patients undergoing total thyroidectomy: prospective randomized control studyReport as inadecuate

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Journal of Otolaryngology - Head and Neck Surgery

, 45:14

First Online: 13 February 2016Received: 02 September 2015Accepted: 04 February 2016DOI: 10.1186-s40463-016-0127-5

Cite this article as: Alsaffar, H., Wilson, L., Kamdar, D.P. et al. J of Otolaryngol - Head & Neck Surg 2016 45: 14. doi:10.1186-s40463-016-0127-5


BackgroundInformed consent consists of basic five elements: voluntarism, capacity, disclosure, understanding, and ultimate decision-making. Physician disclosure, patient understanding, and information retention are all essential in the doctor-patient relationship. This is inclusive of helping patients make and manage their decisions and expectations better and also to deal with any consequences and-or complications that arise. This study investigates whether giving patients procedure-specific handouts pre-operatively as part of the established informed consent process significantly improves overall risk-recall following surgery. These handouts outline the anticipated peri-operative risks and complications associated with total thyroidectomy, as well as the corrective measures to address complications. In addition, the influence of potential confounders affecting risk-recall, such as anxiety and pre-existing memory disturbance, are also examined.

MethodsConsecutive adult ≥18 years old patients undergoing total thyroidectomy at a single academic tertiary care referral centre are included. Participants are randomly assigned into either the experimental group with pamphlets or the control group by a computerized randomization system Clinstat. All participants filled out a Hospital Anxiety and Depression Scale HADS and they are tested by the physician for short-term memory loss using the Memory Impairment Screen MIS exam. All patients are evaluated at one week post-operatively. The written recall questionnaire test is also administered during this clinical encounter.

ResultsForty-nine patients are included - 25 of them receive verbal consent only, while another 24 patients received both verbal consent and patient education information pamphlets. The overall average of correct answers for each group was 83 % and 80 % in the control and intervention groups, respectively, with no statistically significant differences. There are also no statistically significant differences between the two groups, in both interview duration, in time between interviews, and in recall tests. No correlation is also apparent between the pre-op HADS score and the recall questionnaire overall score.

ConclusionsA pre-operative thyroid surgical information pamphlet alone might not be sufficient to enhance patient test scores and optimally educate the patient on their expected care pathway in thyroid surgery. Supplementation with alternative means of patient education perhaps using emerging technologies needs to be further investigated.

KeywordsInformed consent Pamphlets Post-operative risk-recall Total thyroidectomy and patient education AbbreviationsHADSHospital anxiety and depression scale

MISMemory impairment screen

PTHParathyroid hormone

Electronic supplementary materialThe online version of this article doi:10.1186-s40463-016-0127-5 contains supplementary material, which is available to authorized users.

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Author: Hussain Alsaffar - Lindsay Wilson - Dev P. Kamdar - Faizullo Sultanov - Danny Enepekides - Kevin M. Higgins



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