Improving health literacy: informed decision-making rather than informed consent for CT scans in children

Goske, Marilyn J.; Bulas, Dorothy

doi:10.1007/s00247-009-1322-6

Cited by 37 publications

(17 citation statements)

References 18 publications

(20 reference statements)

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“…Even though it appears physicians and patients do not connect over the specifics of radiation exposure risk, there is a strong foundation for a trusting conversation about the topic. Informed decision-making [27][28][29][30] is an ideal model for discussion of CT radiation risk; offering a patient the opportunity to agree to a diagnostic plan creates a space in which radiation exposure can be discussed and simultaneously accounts for the variable nature of the patient-physician relationship.…”

Section: Communication Barriersmentioning

confidence: 99%

Barriers to Computed Tomography Radiation Risk Communication in the Emergency Department: A Qualitative Analysis of Patient and Physician Perspectives

Robey

Edwards

Murphy

2014

Academic Emergency Medicine

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Objectives: This qualitative study aimed to characterize the barriers to informed discussions between patients and emergency physicians (EPs) about radiation risk from computed tomography (CT) and to identify future interventions to improve patient understanding of CT radiation risk.Methods: This study used a focus group approach to collect concepts about radiation risk exposure from a national sample of EPs and a local sample of emergency department (ED) patients. A directed content analysis used an a priori medical ethics framework to explore themes from the focus groups while a subsequent normative ethics analysis compared these results with existing perceptions about discussing CT radiation risk.Results: Focus groups (three each for a total of 19 EPs and 27 patients) identified concepts consistent with core medical ethics principles: patients emphasized autonomy and nonmaleficence more than physicians, while physicians emphasized beneficence. Subjects' knowledge of radiation dose and risk were equivalent to previously published reports. When asked about whether they should talk about radiation with patients, 74% of EPs reported that radiation exposure should be discussed, but the study EPs self-reported doing so with only an average of 24% of patients. Patients reported wanting to hear about radiation from their physicians the next time they need CT scans and thought that a written handout would work better than any other method. When presented with options for how to discuss risk with patients, EPs reported needing easy access to risk information and preferred discussion over other communications approaches, but had mixed support of distributing patient handouts. Conclusions:The normative view that radiation from diagnostic CT should be discussed in the ED is shared by patients and physicians, but is challenged by the lack of a structured method to communicate CT radiation risk to ED patients. Our analysis identifies promising interest among physicians and patients to use information guides and electronic order prompts as potential informational tools to overcome this barrier.ACADEMIC EMERGENCY MEDICINE 2014; 21:122-129

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Section: Communication Barriersmentioning

confidence: 99%

Barriers to Computed Tomography Radiation Risk Communication in the Emergency Department: A Qualitative Analysis of Patient and Physician Perspectives

Robey

Edwards

Murphy

2014

Academic Emergency Medicine

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“…8 It has been suggested that informed consent be obtained for children and young adults undergoing CT examinations. 12 Other authors comment on the difficulty of obtaining consent, because the radiation risk is age dependent and cumulative, 33 or because of the possibility of a parent refusing a justified CT scan. 34 One study surveyed parents of children undergoing CT scans, before and after providing a brochure on radiation safety, and found that the rates of consent to CT scans did not change.…”

Section: Justifying the Scanmentioning

confidence: 99%

“…35 Informed decision making and support resources may be a viable alternative to informed consent. 33 Box 3 provides typical effective doses for paediatric CT examinations with the number of equivalent chest radiographs given as a radiation dose comparator. While it may be desirable to quote a "1-in-x" risk for each type of examination, these types of estimates are not applicable to effective doses.…”

Section: Justifying the Scanmentioning

confidence: 99%

Justifying referrals for paediatric CT

Brady

Cain

Johnston

2012

Medical Journal of Australia

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• The system of radiation protection assumes a linear dose-response relationship with no threshold for low doses and dose rate exposures. This is based on epidemiological evidence at higher doses. • Hence there is a small theoretical risk of carcinogenesis attributable to low doses of ionising radiation. This risk is associated with any diagnostic imaging procedure involving radiation. • Radiosensitivity declines with age, so children are more susceptible to radiation risks than adults. Females are more radiosensitive than males. • The radiation protection system is based on the assumption that radiation risk is cumulative over a lifetime. • For an individual, a justified, optimised computed tomography (CT) scan will result in more benefit than harm. A doctor must justify the necessity for a CT scan before referring an individual for imaging.

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“…In addition to the potential radiation risk, the risk of percutaneous biopsy or thoracoscopic surgery (as well as that related to sedation or anesthesia) may be discussed, as appropriate, in case a decision is made to proceed to tissue sampling of the nodule (s) in question. The careful conduction of such a discussion and the documentation of the understanding of the risks and benefits of follow-up with CT satisfy the requirement of informed decision-making as advocated by the Image Gently campaign and other authorities [20][21][22][23]. Physicians who engage in such discussions with parents and other caregivers should be familiar with the principles of risk communication [24][25][26][27].…”

Section: Communication With the Familymentioning

confidence: 99%

The incidental pulmonary nodule in a child

et al. 2015

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The incidental detection of small lung nodules in children is a vexing consequence of an increased reliance on CT. We present an algorithm for the management of lung nodules detected on CT in children, based on the presence or absence of symptoms, the presence or absence of elements in the clinical history that might explain these nodules, and the imaging characteristics of the nodules (such as attenuation measurements within the nodule). We provide suggestions on how to perform a thoughtfully directed and focused search for clinically occult extrathoracic disease processes (including malignant disease) that may present as an incidentally detected lung nodule on CT. This algorithm emphasizes that because of the lack of definitive information on the natural history of small solid nodules that are truly detected incidentally, their clinical management is highly dependent on the caregivers' individual risk tolerance. In addition, we present strategies to reduce the prevalence of these incidental findings, by preventing unnecessary chest CT scans or inadvertent inclusion of portions of the lungs in scans of adjacent body parts. Application of these guidelines provides pediatric radiologists with an important opportunity to practice patient-centered and evidence-based medicine.

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Improving health literacy: informed decision-making rather than informed consent for CT scans in children

Cited by 37 publications

References 18 publications

Barriers to Computed Tomography Radiation Risk Communication in the Emergency Department: A Qualitative Analysis of Patient and Physician Perspectives

Barriers to Computed Tomography Radiation Risk Communication in the Emergency Department: A Qualitative Analysis of Patient and Physician Perspectives

Justifying referrals for paediatric CT

The incidental pulmonary nodule in a child

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