Quality of informed consent documents among US. hospitals: a cross-sectional study

Quality of informed consent documents among US. hospitals: a cross-sectional study
Original Research
Erica S Spatz, Haikun Bao, Jeph Herrin, Vrunda Desai, Sriram Ramanan, Lynette Lines, Rebecca Dendy, Susannah M Bernheim, Harlan M Krumholz, Zhenqiu Lin, Lisa G Suter
BMJ Open: Cardiovascular Medicine, 19 May 2020; 10(5)
Open Access
Abstract
Objective
To determine whether informed consent for surgical procedures performed in US hospitals meet a minimum standard of quality, we developed and tested a quality measure of informed consent documents.
Design
Retrospective observational study of informed consent documents.
Setting
25 US hospitals, diverse in size and geographical region.
Cohort
Among Medicare fee-for-service patients undergoing elective procedures in participating hospitals, we assessed the informed consent documents associated with these procedures. We aimed to review 100 qualifying procedures per hospital; the selected sample was representative of the procedure types performed at each hospital.
Primary outcome
The outcome was hospital quality of informed consent documents, assessed by two independent raters using an eight-item instrument previously developed for this measure and scored on a scale of 0–20, with 20 representing the highest quality. The outcome was reported as the mean hospital document score and the proportion of documents meeting a quality threshold of 10. Reliability of the hospital score was determined based on subsets of randomly selected documents; face validity was assessed using stakeholder feedback.
Results
Among 2480 informed consent documents from 25 hospitals, mean hospital scores ranged from 0.6 (95% CI 0.3 to 0.9) to 10.8 (95% CI 10.0 to 11.6). Most hospitals had at least one document score at least 10 out of 20 points, but only two hospitals had >50% of their documents score above a 10-point threshold. The Spearman correlation of the measures score was 0.92. Stakeholders reported that the measure was important, though some felt it did not go far enough to assess informed consent quality.
Conclusion
All hospitals performed poorly on a measure of informed consent document quality, though there was some variation across hospitals. Measuring the quality of hospital’s informed consent documents can serve as a first step in driving attention to gaps in quality.

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