World Journal of Surgery

, Volume 43, Issue 2, pp 425–430 | Cite as

Insight in Information Provision Prior to Obtaining Surgical Informed Consent—by Audiotaping Outpatient Consultations

  • B. B. BurgerEmail author
  • M. M. Veerman
  • M. A. Tellier
  • W. K. G. Leclercq
  • C. M. Mouës-Vink
  • P. M. N. Werker
Original Scientific Report



Literature suggests that patient-informing process prior to obtaining surgical informed consent (SIC) does not function well. This study aimed to provide insight into the current practice of SIC in the Netherlands.


This is a prospective, observational, and multicenter study, conducted in one academic and two non-academic teaching hospitals in the Netherlands. Audio recordings were made during outpatient consultations with patients presenting with Dupuytren Disease. The recorded informing process was scored according to a checklist. Written documentation of the SIC process in the patient’s chart was compared to these scored checklists. Time spent on SIC during the consultations was also recorded.


A total of 41 outpatient consultations were included in the study. Consultations were conducted by 25 plastic surgeons and their residents. Average time spent on SIC was 55.6% of the total consultation time. Considerable variation was observed concerning the amount and type of information given and discussed. In 59% of the consultations, discrepancies were observed between written documentation of consultations and audio recordings. Information on treatment risks, the postoperative period, and the operating surgeon was addressed the least.


Despite a relatively large part of the consultation time being spent on SIC, patients received scarce information concerning treatment risks, postoperative period, and who their operating surgeon would be. Discrepancies were observed between the written documentation of SIC and information recorded on the audio recordings. This occurred predominantly in one hospital that used a pre-made list of ‘discussed information’ in its digital patient chart.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests


  1. 1.
  2. 2.
    Royal Dutch Medical Association (KNMG) Department of Internal and External Communication (2004) Report on implementation of the MTCA; from law to practice (part 2, information and consent).
  3. 3.
    Leclercq WK, Keulers BJ, Scheltinga MR et al (2010) A review of surgical informed consent: past, present, and future. A quest to help patients make better decisions. World J Surg 34(7):1406–1415. CrossRefGoogle Scholar
  4. 4.
    Dennis KE (1990) Patients’ control and the information imperative: clarification and confirmation. Nurs Res 39(3):162–166CrossRefGoogle Scholar
  5. 5.
    Brody DS, Miller SM, Lerman CE et al (1989) Patient perception of involvement in medical care: relationship to illness attitudes and outcomes. J Gen Intern Med 4(6):506–511CrossRefGoogle Scholar
  6. 6.
    Shabason JE, Mao JJ, Frankel ES et al (2014) Shared decision-making and patient control in radiation oncology: implications for patient satisfaction. Cancer 120(12):1863–1870CrossRefGoogle Scholar
  7. 7.
    Schenker Y, Meisel A (2011) Informed consent in clinical care practical considerations in the effort to achieve ethical goals. JAMA 305(11):1–1130CrossRefGoogle Scholar
  8. 8.
    Leclercq WK, Keulers BJ, Houterman S et al (2013) A survey of the current practice of the informed consent process in general surgery in the Netherlands. Patient Saf Surg 7(1):4CrossRefGoogle Scholar
  9. 9.
    Keulers BJ, Scheltinga MR, Houterman S et al (2008) Surgeons underestimate their patients’ desire for preoperative information. World J Surg 32(6):964–970. CrossRefGoogle Scholar
  10. 10.
    Knops AM, Ubbink DT, Legemate DA et al (2010) Information communicated with patients in decision making about their abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 39(6):708–713CrossRefGoogle Scholar
  11. 11.
    Dutch Society for Plastic Surgery (Nederlandse Vereniging voor Plastische Chirurgie) (2012) Guidelines on morbus dupuytren.
  12. 12.
    Weckbach S, Kocak T, Reichel H (2016) A survey on patients’ knowledge and expectations during informed consent for spinal surgery: can we improve the shared decision-making process? Patient Saf Surg 10:15CrossRefGoogle Scholar
  13. 13.
    Saigal R, Clark AJ, Scheer JK (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 40(14):85–1079CrossRefGoogle Scholar
  14. 14.
    Kunneman M, Marijnen CA, Rozema T et al (2015) Decision consultations on preoperative radiotherapy for rectal cancer: large variation in benefits and harms that are addressed. Br J Cancer 112(1):39–43CrossRefGoogle Scholar
  15. 15.
    Koedoot CG, Oort FJ, De Haan RJ et al (2004) The content and amount of information given by medical oncologists when telling patients with advanced cancer what their treatment options are: palliative chemotherapy and watchfull-waiting. Eur J Cancer 40(2):35–225CrossRefGoogle Scholar
  16. 16.
    Bismark MM, Gogos AJ, Clark RB et al (2012) Legal disputes over duties to disclose treatment risks to patients: a review of negligence claims and complaints in Australia. PLoS Med 9(8):e1001283CrossRefGoogle Scholar
  17. 17.
    Porta CR, Sebesta JA, Brown TA et al (2012) Training surgeons and the informed consent process: routine disclosure of trainee participation and its effect on patient willingness and consent rates. Arch Surg 147(1):57–62CrossRefGoogle Scholar
  18. 18.
    Patel PB, Gilchrist A, Cronan KM et al (2010) Adequacy of informed consent for lumbar puncture in a pediatric emergency department. Pediatr Emerg Care 26:739–741CrossRefGoogle Scholar
  19. 19.
    Fine A (1977) Informed consent in California, latent liability without ‘negligence’. West J Med 127(2):158–163Google Scholar
  20. 20.
    Bhattacharyya T, Yeon H, Harris MB (2005) The medical-legal aspects of informed consent in orthopaedic surgery. J Bone Jt Surg Am 87(11):2395–2400Google Scholar
  21. 21.
    Tipotsch-Maca SM, Varsits RM, Ginzel C et al (2016) Effect of a multimedia-assisted informed consent procedure on the information gain, satisfaction, and anxiety of cataract surgery patients. J Cataract Refract Surg 42:110–116CrossRefGoogle Scholar
  22. 22.
    Heller L, Parker PA, Youssef A et al (2008) Interactive digital education aid in breast reconstruction. Plast Reconstr Surg 122(3):717–724CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • B. B. Burger
    • 1
    Email author
  • M. M. Veerman
    • 2
  • M. A. Tellier
    • 1
  • W. K. G. Leclercq
    • 3
  • C. M. Mouës-Vink
    • 4
  • P. M. N. Werker
    • 5
  1. 1.Department of Plastic SurgeryIsala Hospital ZwolleZwolleThe Netherlands
  2. 2.Department of Plastic SurgeryHospital Rivierenland TielTielThe Netherlands
  3. 3.Department of Gastrointestinal and Oncologic SurgeryMaxima Medical Center VeldhovenVeldhovenThe Netherlands
  4. 4.Department of Plastic SurgeryMedical Centre LeeuwardenLeeuwardenThe Netherlands
  5. 5.Department of Plastic SurgeryUniversity of Groningen & University Medical Center GroningenGroningenThe Netherlands

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