Factors Affecting Risk Recall in Open Carpal Tunnel Release Surgery

Objective of this study The investigators' study objectives are to see if additionally providing a written document along with the discussion of surgical risks improves risk recall for patient seen in consultation for open carpal tunnel release, and if this has any effect on overall satisfaction after the procedure.

To accomplish this goal, the investigators intend to provide patients with a written document outlining the same risks as are discussed in consultation and investigate if their recall of the risks is improved compared to patients who receive discussion alone. The investigators will also see whether risk recall is affected if patients participate in a group format informed consent discussion compared to a standard individual discussion. The investigators propose to do this as a two-part prospective randomized control trial of patients who are new referrals to the Halifax Infirmary Plastic Surgery Clinic.

Background The informed consent process The risks and benefits of an operation or procedure are typically discussed as part of the informed consent process for an initial surgical consultation. Informed consent is a legal requirement for surgery and is based on the components of disclosure, comprehension, competence and voluntary choice. Despite this, patients are often unable to recall the specific risks that were reviewed. Additionally, failure to understand the possible risks and failure of communication are more common reasons for patients to seek legal action. Patients have historically reported that they wished they had received more information about their operation prior to surgery.

Increased understanding of a procedure and its risks has been shown to give patients more realistic expectations, increase cooperation and result in higher satisfaction. Traditionally, obtaining informed consent for surgical procedures has involved an oral discussion, but this may be insufficient as oral information tends to be poorly retained.

Previous research in the field of otolaryngology has shown that written documentation in addition to oral discussion increases recall of both general knowledge of a procedure and of the specific risks of a procedure. Siau et al. (2010) found that this effect was even more pronounced for recall of the risks associated with the operation and that subjectively patients were found to be happy to have received a pamphlet and found it helpful. Early research into this subject in general surgery suggested that the optimal time to provide additional information regarding a procedure is at the time of the initial consultation or at least one week prior to surgery.