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Informed Consent Does Not Seem to Influence Decision-Making Process For Cataract Surgery

January 08, 2004

Informing patients of the risks of cataract surgery as part of the informed consent procedure one day before surgery does not seem to influence patients' decisions to have the procedure, according to an article in the January issue of The Archives of Ophthalmology, one of the JAMA/Archives journals.

Cataract surgery is the most frequently performed eye surgery and is the cause for one third of all lawsuits against ophthalmologists, according to the article. Cataracts occur when the lens of the eye becomes cloudy and opaque, which can compromise vision. During cataract surgery, the clouded lens is removed, and an artificial lens is placed. Informed consent is a process by which the patient is informed of what will happen during surgery, what the possible risks are, and what he or she can expect during recovery. Cataract surgery has a very low risk of complications, but the number of malpractice claims associated with cataract surgery is rising. For a malpractice claim to be initiated, negligence, injury, and the proximate cause (i.e., the procedure caused the injury) need to be evident, but because malpractice is often hard to prove, inadequate or lack of informed consent is used as a secondary cause in more than 90 percent of all ophthalmologic malpractice cases. It has been well documented in several clinical studies that very little of the information given during the informed consent procedure can be recalled correctly by the patients even one day after surgery, the article states.

Christopher G. Kiss, M.D., of the University of Vienna, Austria, and colleagues studied the decision-making process by patients on the day before cataract surgery and evaluated the extent to which the informed consent process influenced patients' decisions to undergo surgery.

The researchers enrolled 70 patients (average age 70 years) about to undergo cataract surgery. On the day before their surgeries, the 70 patients underwent a standardized informed consent procedure. They were also invited to answer 15 questions developed by clinical psychologists, lawyers and ophthalmologists.

The results of the survey indicated that 28 (40 percent) of the 70 participants arrived for surgery without any information; 16 (23 percent) believed that there were surgical procedures without any risks; and 53 (76 percent) believed that there were no risks for their cataract surgery. Thirty-one patients (44 percent) preferred that their physician make the decision for surgery, while 16 (26 percent) wanted to make the decision together with their ophthalmologist.

The risk of a complication that could compromise sight did not influence 54 patients' (77 percent) decisions, and 55 patients (78 percent) said the informed consent process did not influence their decision. Fifteen patients (22 percent) said that the informed consent process helped confirm their decision to undergo cataract surgery.

The researchers conclude that "informed consent one day preoperatively does not seem to influence the decision for cataract surgery. Cognitive dissonance as part of a decision-making process makes changes in an already chosen option unlikely. The resulting limited decisive potential is very important for credibility in a trail and has to be considered in ophthalmologic surgery," the authors write.

Journal of the American Medical Association (JAMA)

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