The quality and perception of preoperative informed-consent discussions with older patients

BACKGROUND: Informed consent requires the provision and comprehension of adequate information, as well as autonomous decision-making by the patient. We studied whether routine preoperative informed-consent discussions fulfill these prerequisites, and to what extent patients and physicians differ in their assessments of the informed-consent process. METHODS: In a single-center observational study, we asked patients aged 65 and above about the information they had been given, their comprehension of it, and their decision-making autonomy, as well as their personal preference for degree of participation and their subjective need for autonomy. Their physicians were asked to rate the informed-consent discussions that they had conducted. RESULTS: 111 patients and 37 physicians were questioned. Mean values given by the patients preoperatively (out of 100 points) were 84.9 points for information, 77.8 points for comprehension, and 80.2 points for autonomy. The same patients, however, rated their informedness and comprehension markedly lower when asked again after surgery (77.7 and 50.2 points, respectively). Health competence was generally low; higher values were associated with better subjective preoperative informedness (b = 1.943; R² = 0.173) and comprehension (b = 2.526; R² = 0.228; p < 0.001 for both). Physicians tended to overestimate their patients' health competence and to underestimate their need to be informed. CONCLUSION: The older patients preoperatively rated all three prerequisites for informed consent in the top fifth of a 0-100 scale but assessed the informed-consent discussion much more critically when asked again after surgery. Patients' and physicians' assessments differed as well. These findings underscore the need for structured informed-consent discussions that are better aligned with patient-relevant endpoints while also taking account of the fact that older patients often have reduced health competence.