Informed Proxy Consent: Communication Between Pediatric Surgeons and Surrogates About Surgery

Abstract

Communication plays an important role within the surrogate-surgeon dyad. Psychologic variables such as expectations, and the perception of both the surrogates and the surgeons, influence the amount of information that is proffered and the manner in which it is received. Improved communication may be achieved by use of visual aids, discussion of anesthesia and the postoperative course, recognition of the circumstances around the discussion, such as timing and location of the discussion, and personalization of the discussion.

Informed decision-making in elective major vascular surgery: analysis of 145 surgeon–patient consultations

“…Patients are not offered complete information 1 and may not recall information that has been discussed. 2 Consent forms are difficult to read 3 and are often not read. 4 Prior informed decision-making studies have some important limitations.…”

“…Second, the few studies of actual physician-patient conversations do not examine the entire decision-making process across multiple visits when necessary. 1,2,5 Third, many of the clinical decisions in prior studies were low-risk decisions, such as consent for blood-taking or electrocardiograms. In this study, we sought to address the limitations of prior studies by audiotaping actual physician-patient conversations.…”

Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information

“…For instance, being asked to consent to a new aspect of a procedure while standing in the hall the night before surgery caught 1 parent by surprise, coloring her overall satisfaction and perception of the sufficiency of information. 54 Facilitators of improved communication include clear demonstrations of empathy and respect. See Table 2 for additional recommendations.…”

“…137 The expected duration of the surgery, the amount of hair to be removed, the location and length of the incision and bandages, location and purpose of intravenous lines and other assorted tubes, and the child's likely appearance after the procedure are sources of concern that, although routine for practitioners, should be prospectively addressed. 54 Parents consistently state that they need more and clearer information about their children's health status, particularly in the setting of chronic or terminal illness. 50,94,[138][139][140][141][142] Parents of chronically ill children want more information about the child's condition, its treatment, and its long-term implications; 94,142-144 they want that information to be shared with them as soon as it is known.…”

“…143,145 They want their views and concerns factored into the care plan and to be treated like partners (and often experts) in their child's care. 5,53,54,94,137,142,143 They need affirmation of their efforts and assistance with and recognition of the need to preserve family solidarity and support, including social support, child care, education, and professional services; 94,140,143,146 in some studies, parents report assistance with family and social support as their greatest unmet need. 94,142,143 One proposed solution is to have an annual meeting of the family and physician to discuss the "big picture."…”