A 65-year-old man comes to the office for a health maintenance visit. The patient has a history of hypertension and hypercholesterolemia. He smoked two packs of cigarettes per day for 25 years but stopped at age 50. Blood pressure is 128/80 mm Hg and pulse is 74/min. Physical examination shows no abnormalities. Screening abdominal ultrasonography reveals a 6-cm abdominal aortic aneurysm. The patient is referred to a vascular surgeon, who recommends endovascular repair of the aneurysm. Which of the following should be discussed with the patient as part of obtaining informed consent for the procedure?

Question

A 65-year-old man comes to the office for a health maintenance visit.  The patient has a history of hypertension and hypercholesterolemia.  He smoked two packs of cigarettes per day for 25 years but stopped at age 50.  Blood pressure is 128/80 mm Hg and pulse is 74/min.  Physical examination shows no abnormalities.  Screening abdominal ultrasonography reveals a 6-cm abdominal aortic aneurysm.  The patient is referred to a vascular surgeon, who recommends endovascular repair of the aneurysm.  Which of the following should be discussed with the patient as part of obtaining informed consent for the procedure?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d8ac_c1d0_bc81_7b71f87a4530_MD0003_00 Informed consent is the process in which a physician provides the information necessary for the patient to make an educated health care decision. Essential elements include an explanation of: the patient's diagnosis the risks and benefits of both the proposed treatment and the treatment alternatives (eg, endovascular vs open aneurysm repair) the risks of refusing treatment (eg, aneurysmal rupture). It is not required or even feasible to cover all of the possible potential complications, but the physician must discuss common complications and those that are serious, even if they are rare (Choice B). The informed consent discussion should use comprehensible language and be tailored to the patient's level of understanding. For example, patients do not need to know the detailed surgical steps of the procedure but should be informed of the general steps (eg, site of vascular access, use of contrast, placement of graft) (Choice A). The patient should also be given the opportunity to ask questions. After discussion of all these elements, the patient may choose to undergo the procedure and sign a consent form. However, because consent forms are often relatively generic, the specifics of the discussion should be documented in the patient's medical record as the main proof of informed consent. (Choice C) Although some patients may want to know the financial costs of undergoing treatment, this is not an essential element that must be discussed during the informed consent process. In addition, this information is not typically available to the physician and likely varies based on the patient's insurance or health care plan. (Choice D) The informed consent discussion should include an explanation of the diagnosis (eg, what an abdominal aortic aneurysm is) but need not cover the risk factors for the disease (eg, cigarette smoking, hypertension), which might be perceived as placing blame on the patient. (Choice F) The informed consent discussion should include a general explanation of the procedure and the reason it is indicated for the patient's particular diagnosis; however, discussion of the various other indications for the procedure is unnecessary and may cause confusion. Educational objective: Essential elements discussed during the informed consent process include the patient's diagnosis, the risks and benefits of both the proposed treatment and treatment alternatives, and the risks of refusing treatment. References: Informed consent for surgery: risk discussion and documentation. (http://www.ncbi.nlm.nih.gov/pubmed/28234594) Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures. (http://www.ncbi.nlm.nih.gov/pubmed/23832767)

A 65-Year-Old Man Comes to the Office for a Health