Informed Consent in Orthopaedic Surgery: When a Signature Does Not Mean Understanding: A Prospective Study of 750...

Area of Science:

• Orthopaedic Surgery
• Patient Safety
• Medical Ethics

Background:

• Informed consent is crucial in medicine, but patient understanding of surgical details, particularly in orthopaedics, is often uncertain.
• Older and vulnerable populations may face additional challenges in comprehending complex medical information.
• Orthopaedic surgery settings, especially trauma cases, present unique communication barriers due to urgency and stress.

Purpose of the Study:

• To evaluate real-time patient understanding of informed consent immediately before orthopaedic surgery.
• To compare comprehension levels between patients undergoing elective versus trauma-related orthopaedic procedures.

Main Methods:

• A prospective observational study was conducted with 750 adult orthopaedic patients at a tertiary hospital.
• Patients completed a four-item tool assessing understanding of procedure, risks, benefits, and alternatives.
• Comprehension was categorized as absent, partial, or adequate, with exclusions for cognitive impairment or language barriers.

Main Results:

• A significant majority of patients (65.1%) had absent comprehension, and 25.1% had partial comprehension.
• Trauma patients exhibited lower comprehension than elective patients (28.3% vs. 39.1%).
• Adequate comprehension was low across both groups (9.9% overall), with older age and lower education linked to poorer understanding.

Conclusions:

• Most patients undergoing orthopaedic surgery lack meaningful understanding of their consent information.
• Current consent processes appear to have systemic limitations, affecting both elective and trauma pathways.
• Reforming consent into a dynamic verification process with simplified language and teach-back methods is recommended.