2nd February 2018, Volume 131 Number 1469

André van Rij, Jamie Thomas, Rachel McKenzie, Jasper Diong, Frank Frizelle, Jeanne Snelling, Lynley Anderson

In the course of performing an operation, a surgeon will occasionally discover an abnormality that is completely unrelated to the procedure for which patient consent was obtained.1,2 These ‘incidental findings’…

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Summary

When surgeons carrying out an operation incidentally find an unrelated problem, should they go ahead and treat this at the same surgery or wait for another time until having discussed it with the patient? This question was asked of patients awaiting surgery, and the public, to see what they thought were the important things to consider and what they would want to be done by their surgeon in different circumstances. These included whether it was an emergency or not, whether the extra surgery could lead to serious complications or if this might avoid another operation. The results showed that patients and public approached the options similarly although patients more often preferred to go on with the treatment of the IF at the same surgery. Both groups considered the opportunity to avoid another operation to be important. Generally, they preferred for surgeons to discuss the possibility of an incidental finding (IF) during the surgical consent process, although some were not so keen as it might confuse the situation. The preferences were very similar to the way surgeons approached an IF in the same situation as described in the previous paper.

Abstract

Aim

During a surgical procedure, incidental findings (IF) may be found and often the immediate treatment is in the patient’s best interest. Due to the nature of IFs, specific patient consent cannot be obtained under such circumstances. The dilemma is whether the surgeon should proceed or delay until consent is obtained, as there are significant ethical and legal implications. Following an earlier study of surgeons’ preferences for IF management, this report investigates patient and public preferences.

Method

A questionnaire presented hypothetical scenarios involving IFs and samples of patients and public respondents reported their preference to proceed with treatment or have their surgeon wait to obtain consent. Opinion was sought regarding factors influencing their decisions and if general surgical consent procedures should cover IFs.

Results

A sample of 331 respondents from the general public and 368 elective surgery patients were surveyed. Results showed an overall preference to proceed with treatment in 75.1% of the hypothetical scenarios, which increased with IF severity and decreased with procedural risk. Thematic analysis of open-ended questions revealed a number of factors influencing preferences with avoidance of further surgery being most common. Results showed most respondents preferred for information provided in general consent forms though not all were comfortable about this.

Conclusion

Patient and public preferences to proceed with treatment in hypothetical scenarios were generally consistent with surgeons’ reported practice when faced with IFs. The data suggest that an IF clause in the consenting process could help surgeons make clinical decisions best aligned with individual patients’ preferences.

Author Information

André M van Rij, Professor, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin; Jamie Thomas, Assistant Research Fellow, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin;
Rachel McKenzie, Medical Student, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin;  Jasper Diong, Assistant Research Fellow, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin;
Frank Frizelle, Professor, Head of Department, Department of Surgery, University of Otago, Christchurch; Jeanne Snelling, Research Fellow, Bioethics Centre, University of Otago, Dunedin;
Lynley Anderson, Associate Professor, Bioethics Centre, University of Otago, Dunedin. 

Correspondence

André M van Rij, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054.

Correspondence Email

andre.vanrij@otago.ac.nz

Competing Interests

Nil.

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