Understanding patient and surgeon attitudes towards informed consent for sensitive intraoperative exams in colorectal surgery

Background: There is limited understanding of how consent is obtained for digital rectal (DRE) and intraoperative pelvic exams (IPE) in colorectal surgery. Methods: Two-pronged survey of colorectal patients and surgeons. Participants self-rated their agreement with various statements regarding consent for surgery, DRE, and IPE. Results: Out of 90 patients, 77 ​% agreed that surgeons may perform additional procedures other than those explicitly consented to preoperatively. 89 ​% agreed that DRE was implicit in the consent but 65 ​% preferred for it to have been explicitly discussed preoperatively. 75 ​% of patients agreed that IPE was implicit in the consent, but 58 ​% preferred for it to have been discussed preoperatively. Out 49 surgeons, 74 ​% routinely perform maneuvers such as IPE or instrumentation of the vagina when performing stapled anastomoses; only 7 ​% discuss this when obtaining surgical consent. Conclusions: Consent discussions should explicitly include sensitive intraoperative exams to prevent erosion of patient autonomy and trust.