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Kituuka O, Munabi IG, Mwaka ES, Galukande M, Harris M, Sewankambo N. Informed consent process for emergency surgery: A scoping review of stakeholders' perspectives, challenges, ethical concepts, and policies. SAGE Open Med 2023; 11:20503121231176666. [PMID: 37362612 PMCID: PMC10285587 DOI: 10.1177/20503121231176666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Background A scoping review of literature about the informed consent process for emergency surgery from the perspectives of the patients, next of kin, emergency staff, and available guiding policies. Objectives To provide an overview of the informed consent process for emergency surgery; the challenges that arise from the perspectives of the patients, emergency staff, and next of kin; policies that guide informed consent for emergency surgery; and to identify any knowledge gaps that could guide further inquiry in this area. Methods We searched Google Scholar, PubMed/MEDLINE databases as well as Sheridan Libraries and Welch Medical Library from 1990 to 2021. We included journal articles published in English and excluded non-peer-reviewed journal articles, unpublished manuscripts, and conference abstracts. The themes explored were emergency surgery consent, ethical and theoretical concepts, stakeholders' perceptions, challenges, and policies on emergency surgery. Articles were reviewed by three independent reviewers for relevance. Results Of the 65 articles retrieved, 18 articles were included. Of the 18 articles reviewed, 5 addressed emergency informed consent, 9 stakeholders' perspectives, 7 the challenges of emergency informed consent, 3 ethical and theoretical concepts of emergency informed consent, and 3 articles addressed policies of emergency surgery informed consent. Conclusion There is poor satisfaction in the informed consent process in emergency surgery. Impaired capacity to consent and limited time are a challenge. Policies recommend that informed consent should not delay life-saving emergency care and patient's best interests must be upheld.
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Affiliation(s)
- Olivia Kituuka
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Moses Galukande
- Makerere University College of Health Sciences, Kampala, Uganda
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Atsaidis Z, Robitaille S, Guadagno E, Wiseman J, Emil S, Poenaru D. "Your child needs surgery": A survey-based evaluation of simulated expert consent conversations by key stakeholders. J Pediatr Surg 2023; 58:902-907. [PMID: 36828674 DOI: 10.1016/j.jpedsurg.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Consent conversations in pediatric surgery are essential components of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, and others in the healthcare system. The aim of this study is to explore expert consenting practice from the key stakeholders' perspective. METHODS Four senior attending pediatric surgeons obtained consent from a standardized mother of a child requiring surgery in two scenarios: a low-risk elective surgery (inguinal hernia repair - Video 1), and a high-risk emergency surgery (intestinal atresia - Video 2). All sessions were recorded. Families of children who had undergone minor or major surgery, families without medical or surgical background, and healthcare professionals were invited to view and evaluate the videos using a semi-structured questionnaire. RESULTS Out of 251 distributed surveys, 56 complete responses were received. Thirty two participants (57.1%) evaluated video 1 and 24 (42.9%) evaluated. Overall, 22 (69%) respondents to video 1 and 20 (84%) respondents to video 2 were "very satisfied" with the recorded consent conversation. Qualitative responses shared common themes of valuing surgeon empathy, good surgeon communication, patient engagement, and adequate time and information. Suggestions for improvement included additional resources and visual aids, improved patient engagement, and discussion of post-operative expectations. CONCLUSION Our data identifies strengths and gaps in the current consent process from the perspective of patient families and providers. Identified areas for improvement in the informed consent process based on multi-stakeholder input will guide the planned development of a consenting educational video resource. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zoe Atsaidis
- McGill University Faculty of Medicine & Health Sciences, Montreal, Quebec, Canada.
| | - Stephan Robitaille
- Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Jeffrey Wiseman
- Division of Internal Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Sherif Emil
- McGill University Faculty of Medicine & Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Dan Poenaru
- McGill University Faculty of Medicine & Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Selvarajan A, Arulanandam B, Guadagno E, Poenaru D. Family risk communication preferences in pediatric surgery: A scoping review. J Pediatr Surg 2023; 58:891-901. [PMID: 36822973 DOI: 10.1016/j.jpedsurg.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Effective patient-surgeon communication is vital in pediatric surgical practice. However, family (including child) preferences for the format and content of risk communication information are largely unknown. In order to optimize the shared-decision making process, this scoping review explored the family-preferred methods for risk communication in pediatric surgery. METHODS A search was conducted in 7 databases from inception until June 2020 to identify family risk communication preferences in pediatric surgical patients, with language restricted to English and French. Two independent reviewers completed the screening in Rayyan software following PRISMA protocol. Included publications were reviewed for data extraction, analyzed, and assessed for risk of bias using standardized instruments. RESULTS A total of 6370 publications were retrieved, out of which 70 were included. Studies were predominantly from ENT (30.0%), general surgery (15.7%), and urology (11.4%). Family-preferred risk communication methods were classified as visual, verbal, technology-based, written, decision aids or other. Technological (32.4%) and written tools (29.7%) were most commonly chosen by families as their preferred risk communication methods. Written tools were frequently used in general surgery and urology, while technology-based tools were widely used in ENT. Most studies were cross-sectional and had a significant risk of bias. CONCLUSION Eliciting families' preferences for risk communication methods is critical for the implementation of shared decision-making. Different risk communication media appear to be preferred within specific surgical domains. To further improve shared-decision making in pediatric surgery, the development and usage of robust, validated risk communication tools are necessary. LEVEL OF EVIDENCE Level IV (Scoping Review).
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Affiliation(s)
- Arthega Selvarajan
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Brandon Arulanandam
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan Poenaru
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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Understanding the effectiveness of consent processes and conversations in pediatric surgery: A systematic-scoping review. J Pediatr Surg 2022; 57:834-844. [PMID: 36031429 DOI: 10.1016/j.jpedsurg.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The consent conversation in pediatric surgery is an essential part of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, other healthcare workers and the healthcare system. We reviewed the published literature on what key stakeholders perceive are the components of effective and ineffective consenting processes in pediatric surgery. METHODS A medical librarian searched seven databases to retrieve articles looking at the informed consenting process in surgical care for the pediatric population. Two independent reviewers screened all publications and categorized them by stakeholder perspectives (patient/family, surgical team, other healthcare team, and hospital administration or policy maker). General study characteristics, interventions to improve consent and features of effective and ineffective consent conversations were extracted. RESULTS 5079 titles and abstracts were screened, resulting in 88 full-text studies and 43 articles included in the final review. Most publications (51%) discussed informed consent only from the patient/family perspective, while 21% added surgeon's perspective. No study approached the consenting process from the perspective of all stakeholder groups. Effective consent components identified included use of multimedia, presence of multiple conversations prior to surgery, and individualized communication catered to unique family knowledge and needs. In contrast, ineffective conversations did not include a clear assessment of parental understanding, delivered too much information, and did not address parental anxiety. CONCLUSIONS The literature on the consenting process in pediatric surgery is narrow in stakeholder perspectives. Our findings highlight gaps in the literature and opportunities to improve the informed consent processes prior to pediatric surgery.
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Parental Educational Intervention to Facilitate Informed Consent for Pediatric Procedural Sedation in the Emergency Department: A Parallel-Group Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10122353. [PMID: 36553877 PMCID: PMC9778183 DOI: 10.3390/healthcare10122353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/14/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
Abstract
Obtaining valid parental informed consent for pediatric procedures in the emergency department (ED) is challenging. We compared a video-assisted informed consent intervention with conventional discussion to inform parents about pediatric procedural sedation in the ED. We conducted a prospective randomized controlled trial using a convenience sample including the parents of children in the ED in whom procedural sedation for facial laceration was recommended. The video group watched an informational video. Conventional group participants received information from physicians during conventional discussion. The primary outcome was knowledge improvement of the video intervention compared with conventional discussion. The secondary outcome was parental satisfaction. Video and conventional groups comprised 32 and 30 participants, respectively. Mean knowledge scores of parents after intervention [±standard deviation] were higher in the video group (91.67 ± 12.70) than in the conventional group (73.33 ± 19.86). Knowledge score differences were significantly bigger in the video group (coefficient: 18.931, 95% confidence interval: 11.146-26.716). Video group participants reported greater satisfaction than conventional group participants. Parents' comprehension of and satisfaction with the informed consent process for pediatric procedural sedation may be improved with the use of an educational video. Standardized approaches should be developed by healthcare institutions to better educate parents, facilitate treatment decisions, and boost satisfaction in the ED.
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Book F, Goedeke J, Poplawski A, Muensterer OJ. Access to an online video enhances the consent process, increases knowledge, and decreases anxiety of caregivers with children scheduled for inguinal hernia repair: A randomized controlled study. J Pediatr Surg 2020; 55:18-28. [PMID: 31685270 DOI: 10.1016/j.jpedsurg.2019.09.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 09/29/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is limited time within the clinical workflow of most pediatric surgeons to obtain a comprehensive, well informed consent. This study evaluates whether ad-lib access to an online video on the consent dialogue enhances the consent process for inguinal hernia repair (IHR) in children. METHODS The study was approved by the state ethics board. A 6-min video of a consent speech on IHR was produced and uploaded to a nonpublic online channel, explaining the condition, procedure, complications, and postoperative expectations. A total of 50 families were randomized to conventional, face-to-face consenting in clinic either with (intervention) or without (control) access to the online video. During their child's IHR, the parents were asked to complete the State-Trait-Anxiety Inventory (STAI), a modified Friedlander questionnaire on assessing knowledge sufficient to provide informed consent, and a validated satisfaction survey. Scores of the intervention and control group were statistically compared. RESULTS The intervention group demonstrated significantly decreased anxiety measured with the STAI (p = 0,026) and increased knowledge (p = 0,016) compared to controls. There was no difference in satisfaction (p = 0,557). CONCLUSION Preoperatively providing access to an online consent video regarding IHR reduces anxiety and enhances knowledge without altering satisfaction level. Adjunct online videos are a useful tool to enhance the consent process. TYPE OF STUDY Prospective randomized controlled trial. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Friederike Book
- Department of Pediatric Surgery, University Medicine of the Johannes Gutenberg University, Mainz, Germany
| | - Jan Goedeke
- Department of Pediatric Surgery, University Medicine of the Johannes Gutenberg University, Mainz, Germany
| | - Alicia Poplawski
- IMBEI Institute of Medical Biostatistics, Epidemiology and Informatics University Medicine of the Johannes Gutenberg University, Mainz, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, University Medicine of the Johannes Gutenberg University, Mainz, Germany.
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Hornor MA, Liu JY, Hu QL, Ko CY, Wick E, Maggard-Gibbons M. Surgical Technical Evidence Review for Acute Appendectomy Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery. J Am Coll Surg 2018; 227:605-617.e2. [PMID: 30316962 DOI: 10.1016/j.jamcollsurg.2018.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Melissa A Hornor
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH; American College of Surgeons, Chicago, IL.
| | - Jessica Y Liu
- American College of Surgeons, Chicago, IL; Department of Surgery, Emory University, Atlanta, GA
| | - Q Lina Hu
- American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Clifford Y Ko
- American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA; Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Elizabeth Wick
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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Abstract
BACKGROUND Informed consent is an ethical process for ensuring patient autonomy. Multimedia presentations (MMPs) often aid the informed consent process for research studies. Thus, it follows that MMPs would improve informed consent in clinical settings. OBJECTIVE The aim of this study was to determine if an MMP for the informed consent process for ketamine sedation improves parental satisfaction and comprehension as compared with standard practice. METHODS This 2-phase study compared 2 methods of informed consent for ketamine sedation of pediatric patients. Phase 1 was a randomized, prospective study that compared the standard verbal consent to an MMP. Phase 2 implemented the MMP into daily work flow to validate the previous year's results. Parents completed a survey evaluating their satisfaction of the informed consent process and assessing their knowledge of ketamine sedation. Primary outcome measures were parental overall satisfaction with the informed consent process and knowledge of ketamine sedation. RESULTS One hundred eighty-four families from a free-standing, urban, tertiary pediatric emergency department with over 85,000 annual visits were enrolled. Different demographics were not associated with a preference for the MMP or improved scores on the content quiz. Intervention families were more likely "to feel involved in the decision to use ketamine" and to understand that "they had the right to refuse the ketamine" as compared with control families. The intervention group scored significantly higher overall on the content section than the control group. Implementation and intervention families responded similarly to all survey sections. CONCLUSIONS Multimedia presentation improves parental understanding of ketamine sedation, whereas parental satisfaction with the informed consent process remains unchanged. Use of MMP in the emergency department for informed consent shows potential for both patients and providers.
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Li FX, Nah SA, Low Y. Informed consent for emergency surgery--how much do parents truly remember? J Pediatr Surg 2014; 49:795-7. [PMID: 24851773 DOI: 10.1016/j.jpedsurg.2014.02.075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to evaluate parental retention of possible surgical complications in children undergoing emergency laparoscopic appendectomy. METHODS A prospective pilot study involving parents whose children had emergency laparoscopic appendectomy was performed. Parents were counseled regarding 7 potential complications of laparoscopic appendectomy. They were asked to recall this list immediately after the consent process (immediate recall, IR) and before discharge from inpatient stay (delayed recall, DR). A score (0-7) was awarded indicating the number of correct answers. For each recall, parents were also reminded on complications they omitted (prompted recall). One surgeon administered all consents in person. Demographic data were collected. Data were reported as median (range). RESULTS Twenty-one mothers and 10 fathers were recruited, aged 42 years (30-54). Nine (29%) had university or post-graduate education. Score for IR was 2 (0-6). Five (16%) parents scored 0. Upon prompting after IR, 20 (65%) parents had no impression of at least 1 complication. Score for DR was 2 (0-7), while 7 (23%) parents scored 0. At prompting after DR, 25 (81%) had no memory of at least one complication. Eight (26%) demonstrated improved DR scores. Scores were not affected by patient demographics or time between interviews. CONCLUSIONS There is poor parental retention of information provided during operative consent. Hence, proper documentation of this process is essential.
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Affiliation(s)
- Fay Xiangzhen Li
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899
| | - Shireen Anne Nah
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899
| | - Yee Low
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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Cegala DJ, Chisolm DJ, Nwomeh BC. A communication skills intervention for parents of pediatric surgery patients. PATIENT EDUCATION AND COUNSELING 2013; 93:34-39. [PMID: 23602210 DOI: 10.1016/j.pec.2013.03.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 03/03/2013] [Accepted: 03/22/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE It was hypothesized that parents exposed to a communication skills intervention would participate (e.g., ask questions, express concerns) in a pre-surgical consultation more than parents in the control group. METHODS Sixty-five parents of prospective pediatric surgery patients were randomly assigned to either a communication skills intervention (booklet mailed prior to the consultation) or control group. Only initial consultation parents were included, no follow-ups. Audio-recordings of the medical consultations were obtained and the transcripts analyzed utilizing a content-coding system to determine patient participation. Also, parents were given a health literacy test (s-TOFHLA) and a post-interview questionnaire to gather demographic data. RESULTS Intervention parents participated overall significantly more than control parents. Follow-up analyses revealed that intervention parents asked significantly more questions, and engaged in significantly more information verifying and expressing of concerns. There were no significant differences for parents' assertive statements or information provision. Other significant predictors of parents' participation were consultation length and parents' income. CONCLUSION The intervention tested in this study promoted parents' participation in a pre-surgical consultation. As such, it has the potential to improve information exchange between parents and physicians with positive implications for informed consent. PRACTICE IMPLICATIONS Providing parents with communication guidelines prior to a surgical consultation may improve physician-patient communication.
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Affiliation(s)
- Donald J Cegala
- School of Communication and Department of Family Medicine, The Ohio State University, USA.
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Klima J, Fitzgerald-Butt SM, Kelleher KJ, Chisolm DJ, Comstock RD, Ferketich AK, McBride KL. Understanding of informed consent by parents of children enrolled in a genetic biobank. Genet Med 2013; 16:141-8. [DOI: 10.1038/gim.2013.86] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 05/13/2013] [Indexed: 11/09/2022] Open
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