What are the perioperative guidelines for consenting a patient for surgery?

From the Guidelines

Informed consent for surgery requires a thorough discussion with the patient about the procedure, its risks, benefits, and alternatives before the day of surgery, allowing sufficient time for the patient to consider their decision without feeling rushed, as emphasized by the Association of Anaesthetists of Great Britain and Ireland in 2017 1.

Key Elements of Informed Consent

The consent process should include:

• A clear explanation of the nature of the procedure, expected outcomes, and common complications
• Discussion of serious risks specific to the operation and alternative treatment options, including non-surgical approaches
• Documentation of the patient's understanding and voluntary agreement in the medical record
• Consideration of language interpreters to ensure comprehension for patients with limited English proficiency
• Evaluation of medication effects that might impair decision-making capacity, with consent obtained before administering sedatives

Patient-Centered Approach

The patient's preferences, values, and concerns should be taken into account when discussing the procedure and obtaining consent, as highlighted in the 2017 guidelines 1. This patient-centered approach respects autonomy, promotes shared decision-making, and establishes trust between the surgical team and patient.

Emergency Situations

In emergency situations where immediate intervention is necessary to prevent death or serious harm, verbal consent may be used, but it must be fully documented in the medical notes, as recommended by the 2016 guideline for obtaining valid consent for gastrointestinal endoscopy procedures 1.

Special Considerations

For patients with diminished capacity, legal guardians or healthcare proxies must provide consent, and for transgender and gender-diverse patients, specific considerations, such as using preferred names and pronouns, and being aware of gender-affirming care, should be taken into account, as outlined in the 2024 guidance for clinicians and departments 1.

From the Research

Perioperative Guidelines for Consenting a Patient

The process of obtaining informed consent from patients before surgery is a crucial aspect of perioperative care. The following guidelines are based on evidence from various studies:

• Informed Consent: Informed consent is an essential step in helping patients be aware of the consequences of their treatment decisions 2. Patients should be fully informed of the risks and benefits of the procedure and decide accordingly.
• Written Informed Consent: A written informed consent form should be provided to patients, and they should be given sufficient time to read and understand it 2. However, the written form alone may not be sufficient, and oral communication with the physician is also important.
• Oral Communication: Oral communication with the physician is vital in ensuring that patients understand the risks and benefits of the procedure 2, 3. Patients prefer to discuss the risks and benefits with their anesthesia provider alone or in combination with written information.
• Patient Preferences: Patients have different preferences regarding the timing and method of informed consent 3. Some patients prefer to discuss the risks and benefits on the day of surgery, while others prefer to discuss it earlier.
• Patient-Specific Process: Obtaining consent is a patient-specific process, and patient perception of important points that merit discussion can vary with age and employment status 4.
• Shared Decision Making: Informed consent should be conceptualized as shared decision making with patients or their surrogates 5. This approach emphasizes the importance of communication and shared decision making in the context of the patient-surgeon relationship.

Key Elements of Informed Consent

The following elements should be included in the informed consent process:

• Risks and Benefits: Patients should be informed of the risks and benefits of the procedure, including common and rare complications 2, 3.
• Alternatives: Patients should be informed of alternative treatments and their associated risks and benefits 4.
• Surgery Benefits: Patients should be informed of the benefits of the surgery, including the expected outcomes and recovery time 4.
• Complications: Patients should be informed of potential complications, including blood clots, pain, joint failure, limb length discrepancy, and infection 4.

Documentation

The quality of documentation in the consent form is crucial in ensuring that patients are fully informed. The consent form should include the following:

• Clear Language: The consent form should be written in clear and concise language that patients can understand 2.
• Essential Information: The consent form should include essential information about the procedure, including the risks and benefits, alternatives, and potential complications 6, 4.
• Patient Signature: The patient should sign the consent form to indicate that they have understood the information and agree to the procedure 2.