Volitional Delay of Self-Reported Outcomes: Insights from a Case of Intraoperative Awareness with Explicit Recall

Intraoperative awareness with explicit recall (AWR) is a self-reported outcome of interest in clinical practice, quality assurance initiatives, and clinical trials. Combining structured postoperative interviews with a preoperative description of AWR is assumed to ensure prompt patient disclosure. We describe a volitionally delayed reporting of AWR because of the perceived unimportance of nondistressing awareness experiences, despite preoperative education and 2 postoperative interviews. This delay had implications for a major randomized controlled trial on AWR. Volitionally delayed self-reported outcomes may affect statistical comparisons in clinical trials and quality assurance initiatives, and delay the treatment of subsequent sequelae in clinical practice. This limitation should be considered, even when using structured outcome assessment and preoperative education.