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Paper of the Week

Paper of the Week. By Chijioke Chinaka. Different Perception of surgical Risks between Physicians and Patients Undergoing Laparoscopic Cholecystectomy. Massimiliano Tuveri, MD, Giovani Caocci, MD, Fabio Efficace, MF, Fabio Medas, MD, Gary S. Collins, PhD, Salvatore Pisu, MD

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Paper of the Week

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  1. Paper of the Week By Chijioke Chinaka

  2. Different Perception of surgical Risks between Physicians and Patients Undergoing Laparoscopic Cholecystectomy Massimiliano Tuveri, MD, Giovani Caocci, MD, Fabio Efficace, MF, Fabio Medas, MD, Gary S. Collins, PhD, Salvatore Pisu, MD Surgical Laparoscopy, Endoscopy and Percutaneous Technique. Volume 19, Number 4, August 2009

  3. Objectives: • To explore the quality of the informed consent process in patients undergoing laparoscopic Cholecystectomy. • To investigate any difference in patient and physician perception of information disclosure that could compromise the informed consent process. • Retrospective study • cohort of patients undergoing elective laparoscopic cholecystectomy • June 2003 to December 2005 • Two questionnaires • Previous survey developed by multidisciplinary team (psychologists, surgeons and nurses) • 207 consecutive patients with benign biliary disease . • 19 surgeons • Information on their recall perception of the information they provided. • Investigation: • choice to undergo the surgical procedure, • Perception of risk complication as presented by the surgeon.

  4. Multiple logistic regression analysis • Used to determined the predictors of perceived communication factors during the informed consent. • Returned questionnaires. • 181 pt (87.4%) • Age range 25 to 85 • mean age 50yrs. • 19 surgeons • Patients • All except one reported excellent or good levels of satisfaction for the decision to undergo LC • None of them reported regretting the decision • Perception of risk communicated by physician with possible risk of conversion of LC to OC and the perception of been influenced by external sources in making their decision • Not dependant on age, sex or education level • Older patients + those with higher school levels (85%) felt they have a major role in their decision (p = 0.03 ), • Younger patients • Quality of life implication about the surgery was not adequately explained (p = 0.018) • Did not have major role in the decision to undergo LC (p = 0.03) • Higher educated perceived a higher risk of complications (p = 0.048) • Lower educated perceived a lower risk (p = 0.001)

  5. Patients perception of Risk • Conversion from LC to OC (p = 0.002) • Complication risk (p = 0.004) • Significantly higher than those reported by the physician. • The data • Suggests that there are different perceptions of the quality of information provided during informed consent for surgical procedure. • Conclusion • communication aspects deserve particular attention as these could be heavily influenced by patient characteristics (eg, age and education) • physician should be aware that: • disclosing information during informed consent does not necessarily translate into a full understanding of possible risk/benefits of the procedure • Surgical risk may be perceived differently by patients and this perception might be influenced by patient age and education • Major effort should be directed to improve communication skills of physicians during informed consent process. • More prospective research is needed to identify subgroup of patients who might benefit most from a particular communication approach.

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