Autonomous patient consent for anaesthesia without preoperative consultation: a qualitative feasibility study including low-risk procedures
Original Research Article
MarijeMarsman, Wisse M.F. van den Beuken, Wilton A. van Klei, Teus H.Kappen
BJA Open, September 2022
Abstract
Background
Informed consent for anaesthesia is mandatory and requires provision of information and subsequent consent during consultation between anaesthesiologist and patient. Although information can be provided in an electronic format, it is unknown whether this a valid substitute for a consultation. We explored whether provision of digital information is equivalent to oral consultation and whether it enables patients to give electronic informed consent (e-consent) for anaesthesia.
Methods
Qualitative feasibility study using semi-structured interviews in 20 low-risk adults scheduled for minor surgery under general anaesthesia or procedural sedation at a university hospital. Data were analysed using a thematic content analysis approach. During the interviews, patients followed an application that provides information and subsequent e-consenting.
Results
The mean age was 50 yr and patients had good digital skills. Fifteen patients (75%) had previous experience of anaesthesia. The digital application provided enough information for all patients, but eight (40%) preferred consultation with an anaesthesiologist, mainly for personal contact. Patients had different information needs, with previous experiences leading to lower information needs. Nineteen patients had sufficient information to consent autonomously. Most patients considered separate anaesthesia consent superfluous to the surgical consent.
Conclusion
The digital application provided sufficient information and patients valued the information offered and the advantage of processing information at their own pace. This information made patients feel empowered to autonomously consent to anaesthesia without consultation. Remarkably, consent for anaesthesia was considered unimportant, because patients felt they had ‘no choice’ if they wanted to undergo surgery.

Animation Supported Consent Before Elective Laparoscopic Cholecystectomy
Original Scientific Report
Emre Doganay, David S. Wald, Sam Parker & Frances Hughes
World Journal of Surgery, 28 June 2022
Open Access
Abstract
Background
Patient understanding of surgical procedures is often incomplete at the time they are performed, invalidating consent, and exposing healthcare providers to complaints and claims of failure to inform. Remote consultations, language barriers and patient factors can hinder an effective consent pathway. New approaches are needed to support communication and shared decision-making.
Methods
Multi-language digital animations explaining laparoscopic cholecystectomy were introduced at The Royal London Hospital for patients who attended for elective surgery (www.explainmyprocedure.com/lapchole). Patients completed questionnaires on the day of their procedure both before and after introduction of the animations. We assessed patient-reported understanding of the procedure, its intended benefits, the possible risks, and alternatives to treatment in 72 consecutive patients, 37 before (no animation group) and after 35 after introducing the animations into the consent pathway (animation group). Patient understanding in the two groups was compared.
Results
The two groups were well matched in respect of age, sex and whether English was their first spoken language. The proportions of patients who reported they completely understood the procedure, its benefits, risks, and alternatives in the no animation group were 54, 57, 38 and 24% and in the animation group, 91, 91, 74 and 77%, respectively; p < 0.01 for each comparison.
Conclusion
The integration of multi-language laparoscopic cholecystectomy video animations into the patient consent pathway was associated with substantial improvement in reported understanding of the procedure, benefits, risks, and alternatives to treatment. This approach can be applied across all surgical disciplines in a standardised manner in an era of accelerated elective work and remote consultations.

Enhancing informed consent through use of patient-specific 3D printing in skull base neurosurgery: 3D printing in skull base neurosurgery
Shan Yasin Mian, Shubash Jayasangaran, Aishah Qureshi, Mark Hughes
Journal of Neurological Surgery, 27 June 2022
Abstract
Objectives
Informed consent is fundamental to good practise. We hypothesised that a personalised 3D printed model of skull base pathology would enhance informed consent and reduce patient anxiety. Design Imaging (DICOM) files were 3D printed. After a standard pre-surgery consent clinic, patients completed part-1 of a structured questionnaire. They then interacted with their personalised 3D printed model. They then completed part-2 seeking to explore perceived involvement in decision-making, anxiety, concerns (emotional) and lesion anatomical location, surgical risks (factual). Descriptive statistics were used to report responses and text classification tools were used to analyse free text responses.
Setting and participants
14 patients undergoing elective skull base surgery (with pathologies including skull base meningioma, craniopharyngioma, pituitary adenoma, Rathke cleft cyst, and olfactory neuroblastoma) were prospectively identified at a single unit.
Results
After model exposure, there was a net trend towards reduced patient-reported anxiety and enhanced patient-perceived involvement in treatment. 13/14 patients (93%) felt better about their operation and 13/14 patients (93%) thought all patients should have access to personalised 3D models. After exposure, there was a net trend towards improved patient-reported understanding of surgical risks, lesion location, and degree of feeling informed. 13/14 patients (93%) felt the model helped them understand the surgical anatomy better. Analysis of free text responses, after exposure found 47% positive sentiment, 35% neutral, and 18% negative.
Conclusions
In the context of skull base neurosurgery, personalised 3D printed models of skull base pathology can improve surgical consent and reduce patient anxiety.