Informed consent in pediatric anesthesiology

Abstract

Summary Background Informed consent for pediatric anesthesia is unique because it is (1) obtained from surrogates (ie, parents) rather than from the patient and (2) sought after parents have authorized the surgical intervention. There are limited data on how pediatric anesthesia informed and consent discussions are conducted. The purpose of this study was to characterize the content of preanesthesia informed consent discussions and assess their impact on parent recall and understanding. Methods We conducted a cross‐sectional observational study at a tertiary pediatric hospital. We audio‐recorded and transcribed preanesthesia consent discussions between pediatric anesthesia providers and parents of children undergoing elective surgery. Parents were recruited on the day of surgery and completed a survey postdiscussion to assess their recall and perceived understanding. We used directed content analysis to identify 7 informed consent elements: (i) description of the plan; mention of (ii) alternatives, (iii) risks, and (iv) benefits; (v) discussion of uncertainties; (vi) assessment of comprehension; and (vii) solicitation of a decision. We used multivariable logistic regression to explore the association between discussions that included 3 informed consent elements (description of plan, mention of risks, and mention of benefits) and parent recall and understanding of these elements. Results We analyzed 97 discussions involving 41 different anesthesia providers. The element most frequently included in preanesthesia discussions was a description of the plan (100%); the least frequently included was decision solicitation (18%). Seventy‐one percent of discussions included ≥5 informed consent elements and 70% included a description of the plan, mention of risks, and mention of benefits. Parental recall of these 3 informed consent elements was associated with their inclusion in the preanesthesia discussion (75% vs 34%), and more parents understood all 3 elements if they had reported (vs not reported) recall of all 3 elements (97% vs 53%). Conclusion Most pediatric preanesthesia discussions include ≥5 informed consent elements and describe the plan, mention risks, and mention benefits. Inclusion of these latter 3 consent elements was associated with parental recall of these elements but not understanding.

Anesthesiologist to Patient Communication

“…The remaining 10 studies were included, and the Web of Science search returned 2 more studies, resulting in 12 studies for review. [12][13][14][15][16][17][18][19][20][21][22][23]…”

Leading papers in pediatric anesthesia from the last year

“…Este estudo é importante para que a experiência anestésica seja a mais leve a atraumática possível, tanto para as crianças, quanto para os pais ou cuidadores. Gentry et al 47 discursa sobre a importância do consentimento informado para anestesia pediátrica. Neste trabalho, os autores concluem que consentimentos devem conter elementos sobre o plano anestésico, os benefícios e os riscos associados.…”

Investigating understanding in pediatric anesthesia informed consent

“…Sir—The study published by Gentry et al in 2017 provides unique insight into the content of informed consent conversations for pediatric anesthesia care. In their paper, authors explored how the inclusion of discrete elements of informed consent (eg, description of the plan, risks, benefits), parental recall, and perceived understanding are related.…”

“…While studies have identified a need to improve parental understanding in pediatric anesthesia, it must be considered that this need is significantly understated based on the use of subjective reports of understanding. Moreover, subjective measures of the effectiveness of interventions to improve understanding may not be reliable.…”