According to a study by the European Society of Cardiology on informed consent, 4 out of 10 patients do not understand or remember the information given to them before a cardiac procedure.
A pillar of the doctor-patient relationship, informed consent is as much a legal and ethical requirement as it is a relationship of trust based on information. It consists of providing the patient with details of a procedure or surgery, including the risks involved.
Defined in France by article 70 of law 99-641 of July 27, 1999, consent must, according to the Civil Code, “be obtained beforehand except in the case where his condition makes necessary a therapeutic intervention for which it is not able to consent”. This also means that a patient must receive as much information as possible beforehand about his options in order to make a valid choice, without being constrained.
However, if informed consent is defined by law, it is not always applied. This is shown by a study conducted by the European Society of Cardiology and published in the European Journal of Cardiovascular Nursing. According to its authors, 40% of patients surveyed admitted that they did not understand or remember the information they received about percutaneous coronary intervention (PCI).
Misunderstanding of the procedure and its effects
Also known as coronary angioplasty, percutaneous coronary intervention has become the most common procedure in high- and middle-income countries in recent years. It consists in treating, under local anesthesia, treating a narrowed coronary artery by dilating it by means of a probe fitted with an inflatable balloon at its end.
If the PCI does improve blood circulation, reduces the original chest pain and therefore develops the patient’s well-being, it is not a miracle solution for treating coronary artery disease. But the patients do not seem to know it: about 60% of them think that the intervention would cure them of their coronary artery disease.
Additionally, 95% of the patients in the study believed it would reduce their risk of a future heart attack and 91% believed it would increase their life expectancy.
“These beliefs are inconsistent with the clinical trial evidence, which shows that elective PCI is primarily for symptom relief,” said Felicity Astin, professor and study author at the University of Huddersfield. , UK.
Allow more time for healthcare professionals to explain procedures
For Prof. Astin, these results show that health services should be reconfigured to allow enough time for patients and clinicians to discuss the proposed treatment and potential alternatives. “Patients often receive all the information at once. They then feel overloaded, which contributes to forgetting or not understanding what they hear.”
Nearly half (47%) of patients surveyed, for example, would have liked a family member to accompany them when their treatment was explained to them during the informed consent process. And 31% say they would have needed some help understanding written health information.
Rethinking the way information is given
Avenues are being studied to improve patient understanding. First, the writing of leaflets “in clear and simple language”. “In addition, clinicians should ask patients if they need help reading or understanding health information. Patients will not volunteer if they cannot read.”
The specialist also recommends that cardiologists and nurses train in the use of “teach back”. This method consists of giving the information in “pieces” to the patients and then asking them to explain it in their own words to see if they have understood correctly. “The focus is on being a good teacher, not on testing the patient and shaming them. But the staff can only do that if they have the time – that’s why patient journeys need to be configured,” she concludes.
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