International Urogynecology Journal, Dec, 2013, Vol.24(12), p.2099(6)
Byline: Brook L. McFadden (1,6), Melissa L. Constantine (2), Sarah L. Hammil (1), Megan E. Tarr (3), Husam T. Abed (4), Kimberly S. Kenton (3), Vivian W. Sung (5), Rebecca G. Rogers (1) Keywords: Informed consent; Mesh; Midurethral sling Abstract: Introduction and hypothesis We aimed to determine patient recall of specific surgical risks and benefits discussed during consent for midurethral sling (MUS) surgery immediately after consent and at 6 weeks follow-up. Specifically we sought to determine whether or not women recalled specific risks related to the placement of mesh. Methods Surgeons consented patients for MUS in their usual fashion during audio recorded consent sessions. After consent and again at 6 weeks postoperatively, women completed a checklist of risks, benefits, alternatives, and general procedural items covered during consent. In addition, women completed the Decision Regret Scale for Pelvic Floor Disorders (DRS-PFD). Audio files were used to verify specific risks, benefits, alternatives, and procedural items discussed at consent. Recall of specific risks, benefits, and alternatives were correlated with DRS-PFD scores. Results Sixty-three women completed checklists immediately post consent and at 6 weeks postoperatively. Six-week recall of benefits, alternatives, and description of the operation did not change. Surgical risk recall as measured by the patient checklist deteriorated from 92 % immediately post consent to 72 % at 6 weeks postoperatively (p〈.001). Recall of the risk for mesh erosion declined from 91 to 64 % (p〈.001). Recall that mesh was placed during the MUS procedure declined from 98 to 84 % (p=.01). DRS-PFD scores were correlated with poorer surgical risk recall and surgical complications (r=.31, p=.02). Conclusions Recall of MUS surgery risks deteriorated over time. Specifically, women forgot that mesh was placed or might erode. Further investigations into methods and measures of adequate consent that promote recall of long-term surgical risks are needed. Author Affiliation: (1) Division of Urogynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (2) Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA (3) Division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL, USA (4) Division of Urogynecology, Henry Ford Health System, Detroit, MI, USA (5) Division of Urogynecology & Reconstructive Pelvic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA (6) Department of Obstetrics and Gynecology, MSC 10 5580, 1 University of New Mexico, Albuquerque, NM, 87131, USA Article History: Registration Date: 15/05/2013 Received Date: 01/02/2013 Accepted Date: 14/05/2013 Online Date: 02/07/2013 Article note: Presented at the 38th Annual Meeting of the Society of Gynecologic Surgeons, Baltimore, MD, 13--15 April 2012
Cengage Learning, Inc.