The present study aimed to investigate the significance of information symmetry between the physicians and patients undergoing laparoscopic cholecystectomy and the results proposed that little to no significant information asymmetry was present in terms of the benefits associated with this surgical procedure, while the information is asymmetric in terms of its complications between the physicians and patients.
Correlation between demographic characteristics and the significance of information symmetry regarding the surgery
In the present study, a significant indirect correlation was observed between age and the patients’ awareness in terms of the benefits and complications of the surgery. On the other hand, there was a significant direct correlation between the patients' level of education and awareness in terms of the benefits and complications of undergoing laparoscopic cholecystectomy. In a 2015 study by Masoompour et al., a direct correlation was observed between the health literacy and education level of patients, while a significant indirect correlation was present between the health literacy and age, which are consistent with the results obtained in the present study [23]. These findings suggest that age and education level are expected to affect the health literacy in patients, change their awareness regarding their medical condition, and existing treatment plans. As a potential reason for this correlation, one can mention this notion that young and educated individuals are more capable of finding related books and surfing the Internet and Social media in order to increase their information regarding the benefits and complications of medical interventions. Thus, medical ethics dictate that the attending physicians spend more time eradicating any information asymmetry between themselves and senior or less-educated patients.
The significance of information symmetry regarding the complications of the surgery
In the present study, a poor mean score was obtained for the patients' awareness regarding the complications of the surgery. Moreover, previous studies revealed that patients often prefer not to be fully informed about the potential risks and complications of future surgeries, consequently, these studies suggest that providing information to a number of patients about the risks and complications of theirs surgery cause unnecessary stress and anxiety [24, 25].
In a 2016 study by Yasmine, a small portion of patients (18.5%) were aware of the complications associated with their treatment [14]. In another study, it was indicated that only 20% of patients were informed about the complications of their treatment [26]. Furthermore, Oostendrop et al. revealed that more than 95% of patients prefer to be informed about the complications of their treatment, while all physicians were fully aware of this specific desire at the same time [27]. Consequently, invoking unnecessary stress and anxiety in patients can be considered as the main reason which compels physicians not to fully inform the patients about the complications of a treatment plan or surgery. The findings of this study revealed that information asymmetry exists between the physicians and patients in terms of the complications associated with laparoscopic cholecystectomy. As a possible reason for this undesirable information asymmetry, since physicians are well aware of the outstanding benefits associated with laparoscopic surgeries compared to open surgeries, they tend to lead patients to undergo laparoscopic surgeries. Consequently, physicians prefer not to elaborate in detail about the complications of medical interventions due to the onset of avoidable anxiety and stress in patients.
In a study by Farzandipour et al., the level of awareness was evaluated in discharged patients with informed consent about the complications associated with their treatment. It was concluded that 34.2% of patients were unaware of the complications associated with their treatment plan [17]. The findings of that study are inconsistent with that of the present study. As a reason for this inconsistency, one can mention the significant difference between the research populations used in the two studies. It is of note that in patients who voluntarily preferred to be discharged, physicians attempt to inform patients as much as possible about the possible complications of their treatment and provide patients with a wide range of information in order to prevent lawsuits.
The significance of information symmetry regarding the benefits of the surgery
In the present study, the mean score of patients' awareness in terms of the benefits of this surgery was estimated at an acceptable level. In a 2018 study by Chima, around 61% and 57% of patients were informed of the benefits and complications of their treatment, respectively [4]. Although in the present study, patients are more aware of the benefits and less informed of the complications associated with their treatment plans compared to that of the study conducted by Chima in 2018, however, patients were more informed of the benefits of their treatment plans in comparison with that of the complications of their treatment plans in both of these studies. This trend strongly supports the idea that physicians are more likely to elaborate on the benefits of a treatment plan compared to expressing the complications of medical interventions.
The significance of information symmetry regarding alternative therapies
In the present study, about 85% of patients were informed about the alternative therapies for laparoscopic cholecystectomy, which was considered a highly acceptable level of awareness. In a study by chima, around 41% of patients were informed about alternative courses of action [4], given the fact that 81% of patients were informed about the alternative therapies for laparoscopic cholecystectomy in the present study, the findings of these studies are inconsistent. This can be attributed to the highly limited number of alternative therapies for laparoscopic cholecystectomy in the present study. Furthermore, patients had to choose one of the two available surgical procedures as the main treatment in this study, which results in only one alternative treatment plan. However, in the study carried out by Chima, a wide range of alternative therapies caused the patients to be less informed of other available therapies compared to that of the present study. Based on a study by Agu et al., more than two-thirds of patients, regardless of their field of study, prefer to form decisions about the type of treatment they receive [28]. Since a large portion of physicians consider the patients’ right to choose their own treatment out of the presented courses of action, as the most important general ethical guideline to follow [29], thus, it seems crucial that physicians inform patients about alternative therapies so that patients can make an informed decision while considering the benefits and complications of each course of action. This is of utmost importance in terms of medical ethics.
The significance of information symmetry regarding post-discharge information
In the present study, about 80% of patients indicated that the attending physicians provided them with some information at the time of discharge, however, more than two-thirds of the patients stated that the attending physicians failed to adequately inform them about handling possible complications after discharge from hospital. In a 2001 study by Henderson and Zemike, 66% of patients reported that they received standard and adequate information about their pain relief options at home before discharge, while 90% of patients stated that they received adequate information at the time of discharge to deal with the complications of their treatment at home [30]. The results of that study are inconsistent with that of the present study and it can be attributed to the fact that in the present study, only about 28% of participating patients stated that they were provided with adequate information on how to handle possible complications at the time of discharge. As a reason for this inconsistency, one can mention the large difference between the healthcare infrastructures of the countries under review. In the study by Henderson and Zemike, it was stated that a qualified nurse in the relevant department provides the patient with adequate information on how to tackle possible complications at the time of discharge. In the hospital investigated in this study, specific instructions had been developed for nurses to give to patients at the time of discharge, however, for reasons including time-consuming training processes at the time of discharge, little attention is devoted to these processes and are not fully explained according to the patients’ needs. Furthermore, in a study by Ahrens et al., it was shown that medication prescription for patients are not well-written at the time of discharge and are not fully documented in their discharge letters [31]. In yet another study, it was indicated that patients have several misconceptions about postoperative and at-home pain and its management. Thus, debunking these misconceptions requires supportive suggestions and follow-up of healthcare professionals [32]. Based on the above studies and the findings of the present research, it is recommended that the attending physician or a qualified nurse offers the necessary guidelines for pain management or other possible complications and provide complete answers to patients and their caregivers at the time of discharge in order to eradicate dangerous misconceptions. Moreover, only written instructions should be provided to the patients since oral exchanges can be easily misunderstood. These written instructions may include medication prescription, diets, lifestyle and necessary measures that should be taken in the event of a complication. Finally, these suggestions should be fully tailored to the specific characteristics of a patient. For instance, how information is provided to senior or less-educated patients should be different from how information is delivered to other patients and may require a longer period of time.