The concept of patient reflection time in the context of scheduled orthopaedic surgery: A single-centre prospective study. Role of the general practitioner and the surgeon

Introduction. - The decision-making process for surgery is very complex and involves several actors: patient, surgeon, attending physician, trusted person, and many sources of information. This process requires clear, fair and appropriate information. However, the first civil chamber of the French Cour de cassation, in a judgment of March 11, 2010 recalled that it was up to the surgeon to allow time for reflection "adapted to the patient so that the latter can mature the decision. And collect, if desired, other surgical advice or other information". The regulations and case law do not give any details on the duration of this adapted reflection time. The main objective of this work is to study the concept of reflection time and the secondary objective the place of the surgeon and the attending physician in the decision-making process. Materials and methods. - We carried out a prospective longitudinal observational study in the department of Orthopedic, Trauma and Arthroscopic Surgery of the CHRU of Nancy. The cohort was defined by patients hospitalized within the framework of a planned intervention in orthopedic surgery between September 01, 2017 and October 31, 2017. The exclusion criteria were as follows: patients not wishing to participate in the study, or refusing to sign the informed consent protocol, underage patients, patients deprived of their liberty, patients placed under a legal protection measure (curatorship, reinforced curatorship, tutorship). The patients in the cohort were treated in so-called conventional hospitalization. Statistical analyzes are carried out using the most recent version of R software, equipped with all the packages necessary for data analysis Development Core Team (2014). (R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria). The comparative analyzes between the different groups considered are carried out using the Student or Mann-Whitney-Wilcoxon tests depending on the distribution of the quantitative variable studied. The distributions of the qualitative variables are compared by the Chi(2) test or the non-parametric Fisher exact test. Before each analysis, the conditions of application of the tests used are checked (Yates correction). The tests are considered significant at the 5% threshold (alpha threshold value). Results. - One hundred and fourteen patients were included among the 134 operated on during the period. In the decision-making process, several factors come into play: the attending physician (GP) is useful and very useful in 61.7% of cases. In 52.2% of patients, he is the cause of the consultation with the surgeon. Patients make a decision concerning the procedure before having seen the surgeon in 43% of cases thus trusting the GP whose knowledge of pathologies is considered good (87.7%). In the decision-making process, the surgeon is necessary in 70.5% of cases and the trusted person in 20% of cases. The reflection period seems necessary for 45.2% of patients, however only 27.7% of patients would like it to be made mandatory. On average, the estimate of the necessary reflexion period is 25.8 days 95% (17.1-34.5). Conclusion. - Our study is the first to study and to show the links of the different protagonists in the decision-making process: the patient, the general practitioner, the orthopedic surgeon, the person of trust, work in harmony. Each being necessary and having a well-defined place. It emerges from this study that the reflection period is useful in the information process. However, patients consider that it should not be made compulsory by regulations. (C)2021 Published by Elsevier Masson SAS on behalf of l'Academie nationale de medecine.