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Christopher G. Kiss, MD; Sibylla Richter-Mueksch, MD; Eva Stifter, MD; Gabriela Diendorfer-Radner, PhD; Michaela Velikay-Parel, MD; Wolfgang Radner, MD

Arch Ophthalmol. 2004;122:94-98.

Objectives  To investigate decision making by patients on the day before cataract surgery and to evaluate to what extent the informed consent process influences the patients' decision regarding consent.

Methods  On the day before surgery, 70 patients (mean ± SD age, 70.3 ± 10.3 years) underwent a standardized informed consent procedure. They were also invited to answer 15 questions established in interdisciplinary cooperation among clinical psychologists, lawyers, and ophthalmologists.

Main Outcome Measures  We assessed presurgical information and personal estimation of risks in cataract surgery; the patient-physician relationship regarding surgery-related decisions; and evaluations of the informed consent procedure and the patients' decision.

Results  Questionnaire answers indicated that 28 (40%) of the 70 participating patients arrived for surgery without any information; 16 (23%) believed that there were surgical procedures without risks; and 53 (76%) estimated that there were no risks for their cataract surgery. A physician-dominated decision for surgery was preferred by 31 patients (44%); 16 (26%) wanted to decide together with their ophthalmologist. Possible risks of a sight-threatening complication did not influence 54 patients' (77%) decisions, and 55 patients (78%) said the informed consent process did not influence their decision. The remaining 15 (22%) stated that the informed consent process positively confirmed their decision.

Conclusions  Informed consent 1 day preoperatively does not seem to influence the decision for cataract surgery. Cognitive dissonance as part of a decision-making process makes changes in an already chosen option unlikely. The resulting limited decisive potential is very important for credibility in a trial and has to be considered in ophthalmologic surgery.

From the Departments of Ophthalmology and Optometry (Drs Kiss, Richter-Mueksch, Stifter, Radner, and Velikay-Parel) and Otorhinolaryngology and Phoniatrics, Clinical Psychology (Dr Diendorfer-Radner), University of Vienna, Vienna, Austria, and the Austrian Medico-Legal Society, University of Linz, Linz, Austria (Dr Radner).

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