Informed consent in cardiac surgery: is it truly informed?

Area of Science:

• Cardiovascular Surgery
• Medical Ethics
• Health Psychology

Background:

• Informed consent is crucial for elective procedures like coronary artery bypass grafting (CABG).
• Assessing patient understanding of risks, benefits, and alternatives is essential for valid consent.
• Existing methods may not adequately capture patient knowledge levels regarding complex cardiac surgery.

Purpose of the Study:

• To develop and validate a questionnaire for measuring patient knowledge before undergoing elective CABG.
• To identify specific areas where patient understanding is deficient regarding CABG procedures.

Main Methods:

• A questionnaire was designed based on General Medical Council consent guidelines.
• Face-to-face interviews were conducted with 41 patients post-consent for CABG.
• Inter-observer reliability was assessed with four interviewers.
• Construct validity was evaluated against area deprivation index and predicted intelligence quotient (National Adult Reading Test).

Main Results:

• The questionnaire demonstrated satisfactory inter-observer reliability (Spearman's rho, rs = 0.84-0.89).
• Total scores correlated with predicted intelligence quotient (rs = 0.48) but not area deprivation index (rs = 0.01).
• Patients showed lowest knowledge regarding mortality, morbidity, and alternative treatment options' success rates and risks.

Conclusions:

• A validated questionnaire for assessing patient knowledge in myocardial revascularisation was successfully developed.
• The study identified significant knowledge deficits in key areas of informed consent for CABG.
• The questionnaire can be utilized for audits, clinical trials, and evaluating patient education effectiveness in cardiac surgery and other interventions requiring informed consent.