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Original Investigation
July 25, 2019

Association of Preoperative Disclosure of Resident Roles With Informed Consent for Cataract Surgery in a Teaching Program

Author Affiliations
  • 1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
  • 2Wills Eye Hospital, Philadelphia, Pennsylvania
  • 3Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2019;137(9):1045-1051. doi:10.1001/jamaophthalmol.2019.1919
Key Points

Question  What is the association of preoperative disclosure of resident roles with patient consent rates for cataract surgery and what is the patient's subjective experience of this process?

Findings  In this cohort study, about half of community-based patients would consent to resident involvement in cataract surgery, with no associations between baseline characteristics and consent. Thematic categories suggested to have been associated with giving or declining consent included trust in the attending surgeon, contributing to training of future surgeons, and supervision.

Meaning  These findings suggest approximately half of community private practice patients may consent to resident surgery following preoperative disclosure.

Abstract

Importance  Cataract surgery is the most commonly performed intraocular surgery. Academic centers have mandates to train the next surgeon generation, but resident roles are often hidden in the consent process.

Objective  To investigate associations of full preoperative disclosure of the resident role with patient consent rates and subjective experience of the consent process.

Design, Setting, and Participants  Full scripted disclosure of residents’ roles in cataract surgery was delivered by the attending surgeon. Qualitative analysis was conducted from recorded interviews of patients postoperatively regarding consent process experience and choice of whether to allow resident participation. Associations were sought regarding demographic characteristics and consent rates. Patients were recruited though a private community office. Surgery was performed at a single hospital where resident training was routinely conducted. The study included systemically well patients older than 18 years with surgical cataract. They had no previous eye surgery, English fluency, and ability to engage in informed consent decision-making and postsurgery interview. Patients were ineligible if they had monocular cataracts, required additional simultaneous procedures, had history of ocular trauma, or had cataracts that were surgically technically challenging beyond the usual resident skill level.

Interventions  Eligible patients received an informed consent conversation by the attending physician in accordance with a script describing projected resident involvement in their cataract surgery. Postoperatively, patients were interviewed and responses were analyzed with a quantitative and thematic qualitative approach.

Main Outcomes and Measures  Consent rates to resident participation and qualitative experience of full disclosure process.

Results  Ninety-six patients participated. Participants were between ages 50 and 88 years, 53 were men (55.2%), and 75 were white (85.2%). A total of 54 of 96 participants (56.3%; 95% CI, 45.7%-66.4%) agreed to resident involvement. There were no associations between baseline characteristics and consent to resident involvement identified with any confidence, including race/ethnicity (60% [45 of 75] in white patients vs 30.8% [4 of 13] in nonwhite patients; difference, 29.2%; 95% CI, −0.7% to 57.3%; Fisher exact P = .07). Thematically, those who agreed to resident involvement listed trust in the attending surgeon, contributing to education, and supervision as contributing factors. Patients who declined stated fear and perceived risk as reasons.

Conclusions and Relevance  Our results suggest 45.7% to 66.4% of community private practice patients would consent to resident surgery. Consent rates were not associated with demographic factors. Because residents are less often offered the opportunity to do surgery on private practice patients vs academic center patients, this may represent a resource for resident education.

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