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Patient Knowledge in Hand Surgery Pre- and Post- Consultation in the United States and Honduras: A Prospective Comparative Study
Marc E. Walker, MD, MBA; Carolyn Chuang, BS; Craig Moores, MD; Matthew L Webb, AB; Samuel Buonocore, MD; J. Grant Thomson, MD
Yale University, New Haven, CT

Purpose: Patient-physician communication and education is a critical aspect of the patient-doctor relationship and leads to increased patient compliance, satisfaction, and improved outcomes. In hand surgery, patient education is particularly important due to functional impact of surgery, heightened by the potential effect of the benefits and risks of hand surgery on quality of life. Given the frequent lack of long-term follow-up, clear upfront communication is even more essential in the setting of international medical missions where multiple factors may limit understanding. The purpose of this study was to assess the impact of the surgeon consultation and informed consent process on patient education in a US academic hand surgery practice compared with an international hand surgery mission.

Methods: A multi-part survey was administered to new patients presenting to a university hand center over a 3-month period during 2011 and patients presenting to a hand surgery mission during Spring 2012. Demographic data was collected and a quiz was used to assess knowledge of basic hand anatomy, physiology, disease, diagnoses, and surgical risks.

Results: 71 patients participated (university n=36, mission n=35). Pre-consultation quiz score averaged 56% in the university group versus 27% in the mission group (p=0.0001). Post-consultation quiz scores averaged 59% in the university group versus 40% in the mission group (p=0.0001). Only the mission group's quiz score improvement was statistically significant (p<0.05). 93% of the university group reported learning about their condition and diagnosis, but only 40% demonstrated correct insight into their diagnosis and etiology. In the mission group, 73% reported learning about their condition and diagnosis while 53% demonstrated correct insight into their diagnosis and etiology. Although all consultations involved discussion of surgical risks, only 62% of the university group and 52% of the mission group recalled discussing risks of surgery.

Conclusions: This study highlights the impact of the surgeon consultation and informed consent process on patient knowledge in hand surgery at a university practice and international hand surgery mission. Both patient groups presented with little background in hand knowledge, but the mission group displayed greater improvement after surgeon consultation. Both groups over-reported knowledge gains and displayed relatively low retention of surgical risk discussions, strongly questioning the current effectiveness and relative value of the informed consent process. Future research is needed to explore novel methods of healthcare information delivery and retention in hand surgery, as improved patient education has been associated with enhanced clinical outcomes.


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