Getting to know my surgery: Book stories for patient education on surgical pathologies

To the editor, Surgical practice in Latin America has unique characteristics over the actors involved; the pressure on the medical staff is focused on productivity to reduce the endless surgery-waiting lists.1 Surgical patients tend to assume a paternalistic relationship with their surgeon due to significant disparities in medical knowledge between the patient and the doctor.2 These conditions have created a problem in our surgical patient care system, the decreasing emphasis on education for patients with surgical needs. Despite knowing that the successful exchange of medical information with the patient contributes to improved outcomes, including reduced treatment time and hospital stay, surgeons tend to underestimate their patients' desire for preoperative details.3 The informed consent process is often underestimated as a formative moment for patients to fully comprehend their surgical procedure and the associated risks. The development of informed consent forms has not changed significantly in most hospitals over the past decades, with the primary focus being on their legal utility.4 However, the methods of informed consent will vary depending on the context. For instance, in a rural area of Burundi, surgeons conducted verbal informed consent in 69 out of 103 patients, in addition to the 33 women who underwent surgery, 60% requested that their husbands receive and authorize the informed consent for the surgery.5 In Mexico, at an oncology hospital serving as a reference for conducting clinical trials for oncological treatments, informed consent is obtained in a written form using originally English standard forms, these forms are developed by the companies sponsoring these studies, and this method achieved understanding in only 51% of the patients.6 While an Italian study developed an alternative format of informed consent using a video for patients undergoing an invasive cardiological procedure, these patients had significantly higher understanding compared to the group that received the paper format.7 Therefore, Siray ("suture" in Quechua), a group of medical students based in Peru with an interest in global surgery, aims to bring value to the informed consent system and process through the project "Getting to Know My Surgery." This project involves a series of illustrated stories intended to educate patients about their surgical procedures and postoperative care. The objective was to empower patients to participate more actively in surgical decision-making. The project seeks to establish a new approach to informed consent, introducing the concept of "informed consensus," where both the patient and the surgeon propose and agree upon the course of action. As part of the project, seven short stories in book format were developed to explain some of the most common surgical conditions in our country, including cholecystitis, appendicitis, abdominal hernia, spinal hernia, cerebral aneurysm, mastectomy, and cesarea.8 The project participated in a contest offered by Universidad Peruana Cayetano Heredia and received funding, enabling its development and implementation. Once the stories were written, designed, and printed, they were sent to the Hospital Nacional Cayetano Heredia for their implementation. This hospital is located in the second most populous and one of the poorest districts of the capital of Peru, called San Martín de Porres.9 From now on, the books will become part of the care provided in the surgical services of the Cayetano Heredia National Hospital and will be integrated into the informed consent process for our patients (Figure 1).Figure 1.: Photo of the seven short stories just before being delivered to the hospital.We believe that our patient's understanding of their surgical conditions is often deficient, limiting their relationship with their surgeon when it comes to understanding the reasons for opting for a certain surgical strategy, the associated risks, and the importance of postoperative self-care. Patients genuinely desire to receive medical education and understand their illness; however, the significant disparity in medical knowledge compared to their surgeons impairs their ability to participate in decision-making.3 Siray envisions medical education as an opportunity to close these gaps, as the project aims to expand teaching spaces for patients regarding their surgery. To our knowledge, the project represents one of the first initiatives in our country to ensure that patients are fully capable of making decisions when signing informed consent forms for surgical procedures. We hope that more organizations will fund similar projects in the future or continue this one to produce additional volumes to explain other surgical conditions, thereby promoting patient education and providing fair and informed access to their surgeries. Conflicts of interest statement The authors that they have no conflicts of interest with regard to the content of this report.