Difficultés du transfert d’information en vue d’un consentement éclairé

Learning from informed consent litigation to improve practices: A systematic review

OBJECTIVE

To describe the reasons that lead judges to qualify malpractice as a lack of information, then rule in favour or not of the health professional (HP).

METHODS

We conducted a systematic review of case law relating to the breach of disclosure obligations over a ten-year period from 2010 to 2020. We used 3 legal databases: Légifrance, Dalloz and Lexis 360, all identified as the most exhaustive.

RESULTS

Of the 514 law cases included: judges found malpractice owing to lack of information in 377 (73.3%) cases. Among the latter, malpractices were lack of risk information (N = 257, 68.2%), lack of proof of information (N = 243, 64.5%) and/or lack of information on therapeutic alternatives (N = 49, 13.0%). These malpractices resulted in a conviction of the HP in 268 (71.1%) of the cases.

CONCLUSION

Case law is an important source of information for improving the quality of HP, lawyers, and judges' practices.

PRACTICE IMPLICATIONS

This review suggests that.

Does increased patient comprehension decrease preoperative anxiety before digestive surgery?

BACKGROUND

There exists a misalignment between the information given by a surgeon and the information retained by the patient. Inability to assimilate relevant information can be a factor of preoperative anxiety. The aim of this study was to assess patients' information retention according to a Fédération de Chirurgie Viscérale et Digestive (FCVD) questionnaire.

MATERIALS

From 29 June 2020 to 2 August 2020, a prospective, comparative multicenter study was conducted among 89 patients who were about to undergo digestive surgery. They were included either in a standard group (management in accordance with the usual French guidelines) or experimental group, which received a second consultation, one week before surgery. The day before being operated, all the patients filled out 3 questionnaires analyzing their percentage of retention according to two scales: the Amsterdam Preoperative Anxiety and information Scale (APAIS) and the visual analogue scale for anxiety (VAS-A).

RESULTS

Patient comprehension of the FCVD information was 94% and 63% in the experimental and the control groups, respectively (P<0.001). The standard group was significantly more anxious than the experimental group, with VAS-A rates of 6.2 and 4.6 (P=0.014), respectively. On the other hand, according to the APAIS scale, they were similarly anxious, with scores of 11.3 versus 11.9, respectively (P=0.200).

CONCLUSION

A second transmission of exhaustive information shortly before digestive surgery was conducive to improved retention. Enhanced comprehension and memorization reduced preoperative anxiety.

Medicolegal structure, consequences, and recommendations for daily practice: The example of surgical infection

Surgical infections are the leading cause of complications and have major economic consequences and medico-legal fallout. In this article, the author revisits the foundations of medical law in France and reviews the mechanisms of medical liability, the place of recommendations in the definition of "secundum Artem", or the "state-of-the-art", and the necessity to provide high quality information. The author then proposes an approach to improve safety in daily practice.

Proof of patient information: Analysis of 201 judicial decisions

INTRODUCTION

The ruling by the French Court of Cassation dated February 25, 1997 obliged doctors to provide proof of the information given to patients, reversing more than half a century of case law. In October 1997, it was specified that such evidence could be provided by "all means", including presumption. No hierarchy in respect of means of proof has been defined by case law or legislation. The present study analyzed judicial decisions with a view to determining the means of proof liable to carry the most weight in a suit for failure to provide due patient information.

MATERIAL AND METHOD

A retrospective qualitative study was conducted for the period from January 2010 to December 2015, by a search on the LexisNexis^® JurisClasseur website. Two hundred and one judicial decisions relating to failure to provide due patient information were selected and analyzed to study the characteristics of the practitioners involved, the content of the information at issue and the means of proof provided. The resulting cohort of practitioners was compared with the medical demographic atlas of the French Order of Medicine, considered as exhaustive.

RESULTS

Two hundred and one practitioners were investigated for failure to provide information: 45 medical practitioners (22±3%), and 156 surgeons (78±3%) including 45 orthopedic surgeons (29±3.6% of surgeons). Hundred and ninety-three were private sector (96±1.3%) and 8 public sector (4±1.3%). Hundred and one surgeons (65±3.8% of surgeons), and 26 medical practitioners (58±7.4%) were convicted. Twenty-five of the 45 orthopedic surgeons were convicted (55±7.5%). There was no significant difference in conviction rates between surgeons and medical practitioners: odds ratio, 1.339916; 95% CI [0.6393982; 2.7753764] (Chi² test: p=0.49). Ninety-two practitioners based their defense on a single means of proof, and 74 of these were convicted (80±4.2%). Forty practitioners based their defense on several means of proof, and 16 of these were convicted (40±7.8%). There was a significant difference in conviction rate according to reliance on single or multiple evidence of delivery of information: odds ratio, 0.165; 95% CI [0.07; 0.4] (Chi² test: p=1.1×10^-5).

DISCUSSION

This study shows that surgeons, and orthopedic surgeons in particular, are more at risk of being investigated for failure to provide due patient information (D=-0.65 [-0.7; -0.6]). They are not, however, more at risk of conviction (p=0.49). Being in private practice also appeared to be a risk factor for conviction of failure to provide due information. Offering several rather than a single means of proof of delivery of information significantly reduces the risk of conviction (p=1.1×10^-5).

LEVEL OF EVIDENCE

Level IV: Retrospective study.

Is the right to information fulfilled in an emergency department? Patients' perceptions of the care provided

RATIONALE, AIMS AND OBJECTIVE

In an emergency department (ED), the effective exchange of information between patients and health care providers is recognized as being critically important to patient care. The aims of this study were to evaluate the extent to which the right to information is fulfilled in the ED, to ascertain the degree of patient satisfaction with the attention received and to evaluate the relation between satisfaction and the information received, waiting time and seriousness of the emergency.

METHODS

This is a cross-sectional survey that involved 300 patients who consulted an ED during a period of 3 months. The data were obtained by means of a self-administered validated questionnaire: sociodemographic characteristics, variables related with the treatment received and overall satisfaction were obtained. Medical records were also analysed.

RESULTS

The percentages of patients who received information about the reason for a complementary test, discomfort and complications were: 90.4%, 68.3% and 37%, respectively. In all, 98.3% claimed to have understood diagnosis, but when their written answers were analysed only 37.7% were exactly correlated. The percentages of patients who received information about posology, duration and side effects on medication were: 89.9%, 85.7% and 53%, respectively. Overall, 66% of the patients considered the attention they received as 'good' or 'excellent'. There is a statistically significant relation between patient perceptions of received information and overall satisfaction of care and perceived waiting time.

CONCLUSION

Providing the patients with information in all phases of the care process, giving the opportunity to ask questions, resolving doubts and providing legible and easily understood discharge instructions all contribute to increasing patient satisfaction in ED.