Adult Spinal Deformity Patients Recall Fewer Than 50% of the Risks Discussed in the Informed Consent Process Preoperatively and the Recall Rate Worsens Significantly in the Postoperative Period

Rajiv Saigal, Aaron J. Clark, Justin K. Scheer, Justin S. Smith, Shay Bess, Praveen V. Mummaneni, Ian M. McCarthy, Robert A. Hart, Khaled M. Kebaish, Eric Otto Klineberg, Vedat Deviren, Frank Schwab, Christopher I. Shaffrey, Christopher P. Ames

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Study Design. Recall of the informed consent process in patients undergoing adult spinal deformity surgery and their family members was investigated prospectively. Objective. To quantify the percentage recall of the most common complications discussed during the informed consent process in adult spinal deformity surgery, assess for differences between patients and family members, and correlate with mental status. Summary of Background Data. Given high rates of complications in adult spinal deformity surgery, it is critical to shared decision making that patients are adequately informed about risks and are able to recall preoperative discussion of possible complications to mitigate medical legal risk. Methods. Patients undergoing adult spinal deformity surgery underwent an augmented informed consent process involving both verbal and video explanations. Recall of the 11 most common complications was scored. Mental status was assessed with the mini-mental status examination-brief version. Patients subjectively scored the informed consent process and video. After surgery, the recall test and mini-mental status examination-brief version were readministered at 5 additional time points: hospital discharge, 6 to 8 weeks, 3 months, 6 months, and 1 year postoperatively. Family members were assessed at the first 3 time points for comparison. Results. Fifty-six patients enrolled. Despite ranking the consent process as important (median overall score: 10/10; video score: 9/10), median patient recall was only 45% immediately after discussion and video re-enforcement and subsequently declined to 18% at 6 to 8 weeks and 1 year postoperatively. Median family recall trended higher at 55% immediately and 36% at 6 to 8 weeks postoperatively. The perception of the severity of complications significantly differs between patient and surgeon. Mental status scores showed a transient, significant decrease from preoperation to discharge but were significantly higher at 1 year. Conclusion. Despite being well-informed in an optimized informed consent process, patients cannot recall most surgical risks discussed and recall declines over time. Significant progress remains to improve informed consent retention.

Original languageEnglish (US)
Pages (from-to)1079-1085
Number of pages7
JournalSpine
Volume40
Issue number14
DOIs
StatePublished - Jul 15 2015

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Informed Consent
Postoperative Period
Intelligence Tests
Decision Making

Keywords

  • adult spinal deformity
  • complications
  • informed consent
  • mini-mental status examination
  • recall
  • shared decision making
  • video consent

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Adult Spinal Deformity Patients Recall Fewer Than 50% of the Risks Discussed in the Informed Consent Process Preoperatively and the Recall Rate Worsens Significantly in the Postoperative Period. / Saigal, Rajiv; Clark, Aaron J.; Scheer, Justin K.; Smith, Justin S.; Bess, Shay; Mummaneni, Praveen V.; McCarthy, Ian M.; Hart, Robert A.; Kebaish, Khaled M.; Klineberg, Eric Otto; Deviren, Vedat; Schwab, Frank; Shaffrey, Christopher I.; Ames, Christopher P.

In: Spine, Vol. 40, No. 14, 15.07.2015, p. 1079-1085.

Research output: Contribution to journalArticle

Saigal, R, Clark, AJ, Scheer, JK, Smith, JS, Bess, S, Mummaneni, PV, McCarthy, IM, Hart, RA, Kebaish, KM, Klineberg, EO, Deviren, V, Schwab, F, Shaffrey, CI & Ames, CP 2015, 'Adult Spinal Deformity Patients Recall Fewer Than 50% of the Risks Discussed in the Informed Consent Process Preoperatively and the Recall Rate Worsens Significantly in the Postoperative Period', Spine, vol. 40, no. 14, pp. 1079-1085. https://doi.org/10.1097/BRS.0000000000000964
Saigal, Rajiv ; Clark, Aaron J. ; Scheer, Justin K. ; Smith, Justin S. ; Bess, Shay ; Mummaneni, Praveen V. ; McCarthy, Ian M. ; Hart, Robert A. ; Kebaish, Khaled M. ; Klineberg, Eric Otto ; Deviren, Vedat ; Schwab, Frank ; Shaffrey, Christopher I. ; Ames, Christopher P. / Adult Spinal Deformity Patients Recall Fewer Than 50% of the Risks Discussed in the Informed Consent Process Preoperatively and the Recall Rate Worsens Significantly in the Postoperative Period. In: Spine. 2015 ; Vol. 40, No. 14. pp. 1079-1085.
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abstract = "Study Design. Recall of the informed consent process in patients undergoing adult spinal deformity surgery and their family members was investigated prospectively. Objective. To quantify the percentage recall of the most common complications discussed during the informed consent process in adult spinal deformity surgery, assess for differences between patients and family members, and correlate with mental status. Summary of Background Data. Given high rates of complications in adult spinal deformity surgery, it is critical to shared decision making that patients are adequately informed about risks and are able to recall preoperative discussion of possible complications to mitigate medical legal risk. Methods. Patients undergoing adult spinal deformity surgery underwent an augmented informed consent process involving both verbal and video explanations. Recall of the 11 most common complications was scored. Mental status was assessed with the mini-mental status examination-brief version. Patients subjectively scored the informed consent process and video. After surgery, the recall test and mini-mental status examination-brief version were readministered at 5 additional time points: hospital discharge, 6 to 8 weeks, 3 months, 6 months, and 1 year postoperatively. Family members were assessed at the first 3 time points for comparison. Results. Fifty-six patients enrolled. Despite ranking the consent process as important (median overall score: 10/10; video score: 9/10), median patient recall was only 45{\%} immediately after discussion and video re-enforcement and subsequently declined to 18{\%} at 6 to 8 weeks and 1 year postoperatively. Median family recall trended higher at 55{\%} immediately and 36{\%} at 6 to 8 weeks postoperatively. The perception of the severity of complications significantly differs between patient and surgeon. Mental status scores showed a transient, significant decrease from preoperation to discharge but were significantly higher at 1 year. Conclusion. Despite being well-informed in an optimized informed consent process, patients cannot recall most surgical risks discussed and recall declines over time. Significant progress remains to improve informed consent retention.",
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AU - Clark, Aaron J.

AU - Scheer, Justin K.

AU - Smith, Justin S.

AU - Bess, Shay

AU - Mummaneni, Praveen V.

AU - McCarthy, Ian M.

AU - Hart, Robert A.

AU - Kebaish, Khaled M.

AU - Klineberg, Eric Otto

AU - Deviren, Vedat

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N2 - Study Design. Recall of the informed consent process in patients undergoing adult spinal deformity surgery and their family members was investigated prospectively. Objective. To quantify the percentage recall of the most common complications discussed during the informed consent process in adult spinal deformity surgery, assess for differences between patients and family members, and correlate with mental status. Summary of Background Data. Given high rates of complications in adult spinal deformity surgery, it is critical to shared decision making that patients are adequately informed about risks and are able to recall preoperative discussion of possible complications to mitigate medical legal risk. Methods. Patients undergoing adult spinal deformity surgery underwent an augmented informed consent process involving both verbal and video explanations. Recall of the 11 most common complications was scored. Mental status was assessed with the mini-mental status examination-brief version. Patients subjectively scored the informed consent process and video. After surgery, the recall test and mini-mental status examination-brief version were readministered at 5 additional time points: hospital discharge, 6 to 8 weeks, 3 months, 6 months, and 1 year postoperatively. Family members were assessed at the first 3 time points for comparison. Results. Fifty-six patients enrolled. Despite ranking the consent process as important (median overall score: 10/10; video score: 9/10), median patient recall was only 45% immediately after discussion and video re-enforcement and subsequently declined to 18% at 6 to 8 weeks and 1 year postoperatively. Median family recall trended higher at 55% immediately and 36% at 6 to 8 weeks postoperatively. The perception of the severity of complications significantly differs between patient and surgeon. Mental status scores showed a transient, significant decrease from preoperation to discharge but were significantly higher at 1 year. Conclusion. Despite being well-informed in an optimized informed consent process, patients cannot recall most surgical risks discussed and recall declines over time. Significant progress remains to improve informed consent retention.

AB - Study Design. Recall of the informed consent process in patients undergoing adult spinal deformity surgery and their family members was investigated prospectively. Objective. To quantify the percentage recall of the most common complications discussed during the informed consent process in adult spinal deformity surgery, assess for differences between patients and family members, and correlate with mental status. Summary of Background Data. Given high rates of complications in adult spinal deformity surgery, it is critical to shared decision making that patients are adequately informed about risks and are able to recall preoperative discussion of possible complications to mitigate medical legal risk. Methods. Patients undergoing adult spinal deformity surgery underwent an augmented informed consent process involving both verbal and video explanations. Recall of the 11 most common complications was scored. Mental status was assessed with the mini-mental status examination-brief version. Patients subjectively scored the informed consent process and video. After surgery, the recall test and mini-mental status examination-brief version were readministered at 5 additional time points: hospital discharge, 6 to 8 weeks, 3 months, 6 months, and 1 year postoperatively. Family members were assessed at the first 3 time points for comparison. Results. Fifty-six patients enrolled. Despite ranking the consent process as important (median overall score: 10/10; video score: 9/10), median patient recall was only 45% immediately after discussion and video re-enforcement and subsequently declined to 18% at 6 to 8 weeks and 1 year postoperatively. Median family recall trended higher at 55% immediately and 36% at 6 to 8 weeks postoperatively. The perception of the severity of complications significantly differs between patient and surgeon. Mental status scores showed a transient, significant decrease from preoperation to discharge but were significantly higher at 1 year. Conclusion. Despite being well-informed in an optimized informed consent process, patients cannot recall most surgical risks discussed and recall declines over time. Significant progress remains to improve informed consent retention.

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KW - complications

KW - informed consent

KW - mini-mental status examination

KW - recall

KW - shared decision making

KW - video consent

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