Systematic Review of Preoperative Risk Discussion in Practice.

Area of Science:

• Medical Ethics
• Surgical Practice
• Patient Communication

Background:

• Informed consent is a cornerstone of ethical surgical practice, necessitating clear communication of procedural risks.
• Effective risk communication is a skill developed during surgical residency.
• No prior systematic review has comprehensively assessed current practices in preoperative risk disclosure by surgeons.

Purpose of the Study:

• To systematically review existing literature and evaluate the preoperative provision of risk information by surgeons to adult patients.
• To identify current standards and variations in surgical risk disclosure.

Main Methods:

• A systematic literature search was conducted across Ovid MEDLINE, Embase, CINHAL, and PubMed, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
• Three independent reviewers screened studies, requiring two-reviewer consensus for inclusion.
• Studies focusing on objective data regarding preoperative risk disclosure in adult surgical patients were selected, excluding pediatric, trauma, and anesthesia-specific risk studies.

Main Results:

• Out of 12,988 initial papers, 33 met the inclusion criteria for the review.
• High intra-surgeon variability in the disclosure of preoperative risks was the most consistent finding across all study types.
• Studies analyzing consent recordings revealed the lowest rates of risk disclosure, with disparities noted between verbal information and documented records.

Conclusions:

• Significant variation in preoperative risk disclosure by surgeons hinders the ethical and practical aspects of informed consent.
• There are substantial opportunities to improve current surgical communication practices.
• Future efforts should focus on developing standardized tools and techniques to ensure consistent risk communication to surgical patients.