CONSENT QUALITY FOR GYNAECOLOGICAL SURGERY: HYSTERECTOMY AND THE MANAGEMENT OF THE ADNEXA FOR BENIGN DISEASE. A RETROSPECTIVE QUALITATIVE AUDIT

Context: Patient involvement and shared decision making is essential when obtaining surgical consent. The circumstances in which surgical consent is given vary between and within organisations. The information provided to each patient should be consistent and evidence based. Risk management is impacted when there is conflicting data regarding surgical alternatives. In the field of gynaecology, this is particularly relevant to surgical consent for hysterectomy for benign reasons when considering additional options for prophylactic removal of fallopian tubes and/or ovaries. Objective: To define the optimal consenting practice for benign hysterectomy with particular regards to management of the adnexa and compare current practice against this benchmark. Design, Setting, Participants : Retrospective chart review study of a single tertiary teaching hospital in New Zealand. The included 116 participants underwent hysterectomy in 2014. Vaginal hysterectomy, acute surgery, suspected malignancy or previous bilateral salpino-oophorectomy (BSO) were excluded. Interventions: Formulation and distribution of a standards statement to educate clinicians occurred in July 2014 with the aim of improving consent quality. Main Outcome Measure: The individual components of high-quality consent were recorded giving a potential score of 0-6/6. Results: 8% of the cohort overall received ideal consent. There was a trend to improvement following education on standards from 2% to 13%. Conclusion: The majority of the women received inadequate information during the surgical consenting process for hysterectomy for benign disease.