Pre-operative Counselling and Consent

Principles

• Discuss the diagnosis and treatment options at a time and place at which the patient is best able to understand and retain the information.
• Where possible, explain the up to date, relevant information in a way that the patient will understand; and allow time for the patient to process information and ask any questions
• You should not present information in a way that might influence patients’ decision making- explain the options fully
• Make sure to document what was said and decided.  Most cases will also require a separate consent form to be signed.
  • Emphasis that signing a consent form is not final and decision can be reversed at any time.

Note that new consent laws state that you should inform the patient of risks which are ‘material’ to the patient i.e. which are important to them regardless of the likelihood of it happening.  You should, therefore, inform patients not just of common potential risks, but those that might impacts on them most (note that most of these would be in both categories, though some may not).

Types of consent forms

1. Patient able to consent for themselves
2. Those requiring parental consent
3. Those requiring parental consent BUT where the procedure does not involve loss of consciousness
4. Patients who lack capacity.

Discussion

• WIPE (wash hands, introduce, gain permission, explain the basis for discussion)
• Points to cover
  • Diagnosis; current symptoms; prognosis if left untreated
  • Alternative options for treatment/investigation (including not to treat)
  • The purpose of proposed treatment; what it will entail (e.g. duration, procedure)
  • How the patient should prepare (including medication management)
  • Risks/side effects as well as benefits (include probabilities where possible)
  • What will happen after (short and long-term)
  • Who will be involved (and who is responsible for what; include also any students)
• It is good to check that the patient has understood everything (/what the patient wishes/does not wish to know)
  • Ask them if they have any concerns/questions
  • Ask them, if possible, to describe the procedure to you
• Provide written information where possible.

Common complications/risks/side effects

• Infection
  • Wound site
  • Post op HAP (chest, urinary)
• Pain
• Bleeding (during and post-operatively)
• Thrombosis (usually post op)
• Complications of anaesthetic (e.g. N&V; confusion; disorientation)