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The impact of iMedConsent(TM) on patient decision making among Veterans considering cholecystectomy and inguinal herniorrhaphy

Hall DE, Hanusa BH, Switzer GE, Fine MJ, Arnold RM. The impact of iMedConsent(TM) on patient decision making among Veterans considering cholecystectomy and inguinal herniorrhaphy. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.




Abstract:

Objectives: VA recently implemented iMedConsent(TM), a procedure-specific, computer-based tool for documenting informed consent. Our aim was to assess the impact of this tool on veterans' knowledge about and participation in surgical decisions. Methods: Veterans presenting to the general surgery clinic at VA Pittsburgh for possible cholecystectomy or inguinal herniorrhaphy were eligible. We administered questionnaires before and after the clinic appointment containing previously validated measures of information preference, anxiety, trust in the surgeon, ambivalence about the surgical decision, and comprehension of procedure-specific risks, benefits, and alternatives. We also assessed sociodemographic characteristics and baseline health (SF-12). We compared pre- and post-appointment scale scores with random effects regressions for continuous variables and tests of marginal homogeneity for categorical outcomes. Results: Of the 104 eligible veterans, 75 completed pre-appointment questionnaires and 29 declined participation. After evaluation by the surgeon, 31 patients were not offered surgery. 44 patients documented their informed consent to surgery using iMedConsent(TM), and of these, 38 (86%) also completed a post-appointment questionnaire. There were no demographic differences in the 38 who completed the post-appointment questionnaires and the 37 who did not. In the 38 who completed the study, there were 2 female and 3 African American participants, the mean age was 57.2 (range 28-81), 92% had completed high school, and 34% had incomes > $30,000. Patients' comprehension of procedure-specific risks benefits and alternatives improved from 50% pre-appointment to 60% after the clinic visit (p < .001). No pre-and post-appointment differences were noted in ambivalence, trust, or anxiety. After the clinic visit, more veterans expressed a preference for participating in decision making with their doctor (70% to 97%, p = .006). However, fewer expressed a preference for knowing all possible details about their illness (83% to 26%, p = < .001). Implications: The informed consent process using iMedConsent(TM) improves patient comprehension of procedure-specific risks, benefits, and alternatives. It also empowers patients to participate more actively in the decision-making process. However, the process may provide more detail than patients want regarding their illness. Impacts: This study provides evidence for the effectiveness of iMedConsent(TM) to improve veterans' knowledge about and participation in surgical decisions.





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