Patient recall 6 weeks after surgical consent for midurethral sling using mesh

• Published in: International Urogynecology Journal Vol. 24; no. 12; pp. 2099 - 2104
• Main Authors: McFadden, Brook L., Constantine, Melissa L., Hammil, Sarah L., Tarr, Megan E., Abed, Husam T., Kenton, Kimberly S., Sung, Vivian W., Rogers, Rebecca G.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-12-2013; Springer Nature B.V
• Subjects: Adult; Female; Gynecology; Health Knowledge, Attitudes, Practice; Humans; Informed Consent - psychology; Medicine; Medicine & Public Health; Mental Recall; Middle Aged; Original Article; Postoperative Period; Risk Assessment; Risk Factors; Suburethral Slings - adverse effects; Surgical Mesh - adverse effects; Surveys and Questionnaires; Time Factors; Urinary Incontinence, Stress - surgery; Urology; Midurethral sling; Informed consent; Mesh
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-013-2136-5

Introduction and hypothesis
We aimed to determine patient recall of specific surgical risks and benefits discussed during consent for midurethral sling (MUS) surgery immediately after consent and at 6 weeks follow-up. Specifically we sought to determine whether or not women recalled specific risks related to the placement of mesh.
Methods
Surgeons consented patients for MUS in their usual fashion during audio recorded consent sessions. After consent and again at 6 weeks postoperatively, women completed a checklist of risks, benefits, alternatives, and general procedural items covered during consent. In addition, women completed the Decision Regret Scale for Pelvic Floor Disorders (DRS-PFD). Audio files were used to verify specific risks, benefits, alternatives, and procedural items discussed at consent. Recall of specific risks, benefits, and alternatives were correlated with DRS-PFD scores.
Results
Sixty-three women completed checklists immediately post consent and at 6 weeks postoperatively. Six-week recall of benefits, alternatives, and description of the operation did not change. Surgical risk recall as measured by the patient checklist deteriorated from 92 % immediately post consent to 72 % at 6 weeks postoperatively (
p
 < .001). Recall of the risk for mesh erosion declined from 91 to 64 % (
p
 < .001). Recall that mesh was placed during the MUS procedure declined from 98 to 84 % (
p
 = .01). DRS-PFD scores were correlated with poorer surgical risk recall and surgical complications (
r
 = .31,
p
 = .02).
Conclusions
Recall of MUS surgery risks deteriorated over time. Specifically, women forgot that mesh was placed or might erode. Further investigations into methods and measures of adequate consent that promote recall of long-term surgical risks are needed.