Information in practice

Limits to patient choice: example from anaesthesia

Rachel Markham, specialist registrar, Andrew Smith, consultant anaesthetist. 

Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster LA1 4RP

Correspondence to: A Smith andrew.smith{at}rli.mbht.nhs.uk

Patients have a right to information about their care. Information allows better understanding and greater involvement and enables patients to make choices if they wish.¹ Information is also crucial to the concept of consent to treatment.²

Food and drink are withheld from people undergoing routine general anaesthesia, traditionally from midnight on the day of surgery. Recent evidence indicates that prolonged fasts are unnecessary in healthy people; one typical guideline allows a light meal six hours before and clear fluids up to two hours before induction of anaesthesia.³ How is this information presented to patients?

	Methods and results

Top Methods and results Comment References

We carried out a survey and textual analysis of materials gathered from 267 anaesthetic departments in the United Kingdom as part of the Royal College of Anaesthetists' patient information project.⁴ We noted the length of fast recommended, the explanation and evidence cited for this, and the tone of text used. Both authors agreed on the classification of the tone of the text. Out of 51 leaflets about general anaesthesia in adults, only 27 mentioned preoperative fasting. Fourteen of these suggested times reflecting up to date evidence.³ Eight did not specify a fasting period. Three advocated "nil by mouth from midnight" for both morning and afternoon operations. Eighteen explained why fasting was necessary. None quoted research evidence to support the stated times. The table reports the tone of the text used.

	Comment

Top Methods and results Comment References

Preoperative fasting is one aspect of perioperative care about which patients may wish to exercise a choice, but our survey shows that it is dealt with poorly in written information materials. Good patient information should describe what will happen, explain why, and highlight possible choices with risks and benefits. Providing such materials implies that patients will be involved and choices offered. However, we believe the suggestion that patient choice is akin to consumer choice in general is misleading and unfair to patients. We outline three limiting factors.

	Acknowledgments

We thank the Royal College of Anaesthetists' patient information project for access to the leaflets studied and Charlotte Williamson for her comments on an earlier draft of this paper.

Contributors: AS conceived and designed the study. RM and AS analysed and interpreted the data and wrote the paper. AS will act as guarantor.

	Footnotes

Funding: None.

Competing interests: None declared.

	References

Top Methods and results Comment References

1.	Coulter A. After Bristol: putting patients at the centre. BMJ 2002; 324: 648-651[Free Full Text].
2.	Department of Health. Good practice in consent implementation guide: consent to examination or treatment. London: Department of Health, 2001.
3.	American Society of Anesthesiologists Task Force on Preoperative Fasting. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologists Task Force on Preoperative Fasting. Anesthesiology 1999; 90: 896-905[CrossRef][Web of Science][Medline].
4.	Lack JA, White L, Thoms G, Rollin AM, Williamson C, eds. Patient information: raising the standard. London: Royal College of Anaesthetists, in press.
5.	Smith R. The discomfort of patient power. BMJ 2002; 324: 497-498[Free Full Text].

(Accepted 1 February 2003)