Digital Online Anaesthesia Patient Informed Consent before Elective Diagnostic Procedures or Surgery: Recent Practice in Children—An Exploratory ESAIC Survey (2021)
Claudia Neumann, Grigorij Schleifer, Nadine Strassberger-Nerschbach, Johannes Kamp, Gregor Massoth, Alexandra Görtzen-Patin, Dishalen Cudian, Markus Velten, Mark Coburn, Ehrenfried Schindler, Maria Wittmann
Journal of Clinical Medicine, 19 January 2022
Open Access
Abstract
Background
One undisputed benefit of digital support is the possibility of contact reduction, which has become particularly important in the context of the COVID-19 pandemic. However, to the best of our knowledge, there is currently no study assessing the Europe-wide use of digital online pre-operative patient information or evaluation in the health sector. The aim of this study was to give an overview of the current status in Europe.
Methods
A web-based questionnaire covering the informed consent process was sent to members of the European Society of Anaesthesia and Intensive Care Medicine (ESAIC) in 47 European countries (42,433 recipients/930 responses). Six questions related specifically to the practice in paediatrics.
Results
A total of 70.2% of the respondents indicated that it was not possible to obtain informed consent via the Internet in a routine setting, and 67.3% expressed that they did not know whether it is in line with the legal regulations. In paediatric anaesthesia, the informed consent of only one parent was reported to be sufficient by 77.6% of the respondents for simple interventions and by 63.8% for complex interventions. Just over 50% of the respondents judged that proof of identity of the parents was necessary, but only 29.9% stated that they ask for it in clinical routine. In the current situation, 77.9% would favour informed consent in person, whereas 60.2% could imagine using online or telephone interviews as an alternative to a face-to-face meeting if regulations were changed. Only 18.7% participants reported a change in the regulations due to the current pandemic situation.
Conclusion
Whether informed consent is obtained either online or on the telephone in the paediatric population varies widely across Europe and is not currently implemented as standard practice. For high-risk patients, such as the specific cohort of children with congenital heart defects, wider use of telemedicine might provide a benefit in the future in terms of reduced contact and reduced exposure to health risks through additional hospital stays.

Symptomatic Features and Factors Associated With Do-Not-Resuscitate Consent in Advanced Cancer Patients Admitted to Palliative Care Ward
Research Article
Rongrong Fan, Siyu Yang, Xiaofan Bu, Yongyi Chen, Ying Wang, Boyong Shen, Cuiling Qiu, Xuying Li
American Journal of Hospice and Palliative Medicine, 18 January 2022
Abstract
This study aimed to conduct a retrospective cross-sectional study to investigate the prevalence of symptoms and symptom clusters on sociodemographic and disease characteristics, as well as factors associated with Do-Not-Resuscitate (DNR) consent. Advanced cancer patients were enrolled between 2018 and 2020 with available data. Demographic and clinical data were obtained for analysis from Hospital Information System (HIS) in China. Symptom clusters were extracted by hierarchical cluster analysis. Chi-square test and multiple logistic regression were conducted to investigate the prevalence characteristics of symptoms and influencing factors of DNR consent, respectively. 798 advanced cancer patients were enrolled. The most prevalent symptoms were pain (93%), anorexia (36.5%), and sleep disorders (34.2%). High heart rate was associated with poor performance status and more symptoms. Three clusters were extracted: fatigue-related, respiratory-circulatory system, and digestive system symptom clusters. The incidence of symptoms was statistically significant in age, gender, education level, residence, BMI, performance status, distress score, ADL, and primary pain level. The DNR signature rate was 15.5%. Female, distant metastasis, in-ward rescue, and appearance of dyspnea were independent influencing factors of DNR signature…

Toward Personalized Informed Consent in Cancer Care
Editorial
Anne Lanceley
Medical Anthropology, 18 January 2022
Excerpt
…As the articles in this volume show, people with cancer may experience profound emotional distress, bewilderment, and loss and are often challenged to engage in life while living with symptomatic disease and closeness to death. This circumstance may dramatically alter support needs and personal relationships, threaten psychological well-being, and present challenges for patients and families to say and navigate a complex health care system. The papers present different facets of the profound uncertainty and unpredictability that characterizes twenty-first-century cancer care for patients and clinicians. To me the articles reflect patients’ and health care professionals’ struggle with the risk calculus involved in consenting to treatments where outcomes are unproven, a struggle that has recently been embellished by the uncertainty of COVID-19…

Medical Student Attitudes on Explicit Informed Consent for Pelvic Exams Under Anesthesia
Original Reports
Benjamin E Zuchelkowski, Soukaina Eljamri, Jill E McDonnell, Bhavya Varma, Natalie G Stern, Scott D Rothenberger, Kavita Shah Arora, Judy C Chang
Journal of Surgical Education, 17 January 2022
Abstract
Objective
To obtain an overview of medical student attitudes on the need for explicit consent for pelvic exams under anesthesia performed for educational purposes
Design
From February to October 2020, 201 medical students at a single medical school in the United States participated in a cross-sectional survey after completion of the obstetrics and gynecology clerkship. Outcome measures included endorsement of need for explicit informed consent for educational pelvic exams under anesthesia, and knowledge of informed consent processes for such exams.
Setting
University of Pittsburgh School of Medicine
Participants
Third- and fourth-year medical students
Results
Overall, 75% of medical students endorsed a need for explicit informed consent for educational pelvic exams under anesthesia, which extended to prostate, rectal, and breast exams under anesthesia. Additionally, 45% and 77% of these participants indicated that consent for educational pelvic exams under anesthesia should take the form of a separate signature line on the surgical consent form and/or a verbal form, respectively. Only 40% of students correctly identified institutional policy for obtaining informed consent for educational pelvic exams under anesthesia. Rotation with the oncologic surgical service (p = 0.02) and correct identification of institutional informed consent policies (p = 0.002) were associated with decreased perceptions of the importance of explicit informed consent for educational pelvic exams under anesthesia.
Conclusions
Medical students at the institution studied largely support explicit informed consent for educational pelvic and other sensitive exams under anesthesia, but a knowledge gap on institutional informed consent policy exists. Medical students support increased transparency and bodily autonomy. Due to the agreement of patients and medical students and the ethical rationale for this position, it may be appropriate for physicians and institutions to consider new processes of obtaining explicit informed consent for pelvic exams under anesthesia by medical students.

Variation in the interpretation and application of the Medicaid sterilization consent form among Medicaid officials
Original Research Article
Colin B. Russell, Neena Qasba, Megan L. Evans, Angela Frankel, Kavita Shah Arora
Contraception, 14 January 2022
Abstract
Objective(s)
The Medicaid consent policy has been identified as a major barrier to desired permanent contraception, particularly for low-income communities and communities of color. As each state may modify their state Medicaid sterilization consent form, variation in the form has been reported. This study aims to characterize state-level variation in Medicaid Title XIX consent form interpretation and application.
Study Design
We aimed to collect primary data from Medicaid officials in all 50 United States from January to May 2020 via a 25-question electronic survey regarding state-level consent form implementation. Questions targeted consent form details and definitions, insurance and billing, clinician correspondence, and administrative processes. We used Qualtrics XM® to collect survey responses. We performed descriptive statistics on the survey responses. There were no exclusion criteria.
Results
We had 41 responses from 36/50 states (72% participation rate). Heterogeneity existed in the key definitions of “Premature Delivery” and “Emergency Abdominal Surgery.” One in five respondents reported the consent form was only available in English. Variation among Current Procedural Terminology codes covered in each state’s sterilization policy were noted. Nearly a quarter of respondents did not know how Medicaid informed healthcare providers of consent form denials. Most participants (90%) were unaware of differences between state sterilization policies.
Conclusion
This study demonstrates variation in terms of consent form definitions, procedures covered, correspondence with clinicians, and administrative review processes among state Medicaid offices regarding the sterilization consent form. Greater transparency is necessary in order to reduce administrative barriers to desired permanent contraception.

Consent Issues in the Management of Acute Ischemic Stroke
AAN Position Statement
Justin A. Sattin, Winston Chiong, Richard J. Bonnie, Matthew P. Kirschen, James A. Russell
Neurology, 11 January 2022; 98(2)
Abstract
This position statement briefly reviews the principle of informed consent, the elements of decisional capacity, and how acute stroke may affect this capacity. It further reviews the role of surrogate decision-making, including advance directives, next of kin, physician orders for life-sustaining treatment, and guardianship. In some cases of acute stroke in which the patient lacks decisional capacity and no advance directives or surrogates are available, consent to treatment may be presumed. The document describes the rationale for this position and various considerations regarding its application to IV thrombolysis, neuroendovascular intervention, decompressive craniectomy, and pediatric stroke. The document also reviews consent issues in acute stroke research.

Procedural-based Specialties Benefit from a Formal Informed Consent and Disclosures Educational Program
Original Reports
Valeda Yong, Huaqing Zhao, Kimberly Gilmore, Jane Cripe, Charles Conklin, Elizabeth Dauer
Journal of Surgical Education, 6 January 2022
Abstract
Objective
At our tertiary academic center, residents undergo formalized training in obtaining informed consent and disclosing a complication. The informed consent portion has previously been shown to benefit a group of surgical and emergency medicine residents. We aimed to determine if the benefits from training persist across a larger number of procedural-based specialties and to ascertain the benefit of training in disclosing complications.
Design
This retrospective cohort study examined first-year residents from seven procedural-based specialties who participated in a formal informed consent and disclosures training program, consisting of a didactic lecture and two-part simulation. Two years after the start of the program, the disclosure scenario was added. Participants were given pre- and post-surveys assessing comfort and confidence in the informed consent and disclosure scenarios. Survey results were compared using the signed-rank test and Kruskal-Wallis test as appropriate.
Setting
This study occurred at Temple University Hospital, a tertiary academic institution in Philadelphia, PA.
Participants
First-year residents from 2014 to 2020 in seven procedural-based specialties, including general surgery, orthopedic surgery, otolaryngology, obstetrics and gynecology, emergency medicine, radiology, and anesthesia, participated in this study. One hundred and ninety-three residents completed the program and surveys.
Results
Residents reported improved confidence in filling out an informed consent form (p = 0.036) and more comfortable in obtaining informed consent (p = 0.041), as well as more confidence (p = 0.018) and comfort (p = 0.001) in disclosing a complication. Surgical residents demonstrated greater confidence in obtaining informed consent (p = 0.009) and disclosing a complication (p = 0.0002) after training than non-surgical residents.
Conclusions
Across multiple procedural-based specialties, formal training in informed consent and disclosure of complications increases resident ability to perform these tasks. A formal training program is valuable for residents who are expected to perform these tasks across various specialties.

Is Informed Consent Ever Truly Informed? [BOOK CHAPTER]
Johelen Carleton, Pringl Miller
Difficult Decisions in Surgical Ethics, 1 January 2022; pp 77-89 [Springer]
Abstract
The clinical ethical imperative to provide patients or their surrogate decision makers with relevant and tailored information is a serious endeavor that has challenged many generations of surgeons. The surgical informed consent process (SIC) is a critical aspect of surgical practice that is especially complex because patients are diverse individuals who do not automatically fit into algorithms. The sensitivity and specificity with which the SIC process must be embraced should be seen through the lens of each autonomous person. During SIC it is vital to understand what matters most to the patient. Only then can a surgeon facilitate a meaningful discussion that will honor a patient’s rights, dignity, preferences, goals and values. This chapter will address the evolution of the medicolegal and ethical aspects of the surgical informed consent process and how to optimally satisfy the communication needs. Additionally, this chapter will explore the adaptations to the surgical informed consent process during the COVID-19 pandemic.

Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent
Article
Hui-Mei Lin, Chih-Kuang Liu, Yen-Chun Huang, Chieh-Wen Ho, Mingchih Chen
International Journal of Environmental Research and Public Health, 31 December 2021; 19(428)
Open Access
Abstract
Background
The decision to sign a do-not-resuscitate (DNR) consent is critical for patients concerned about their end-of-life medical care. Taiwan’s National Health Insurance Administration (NHIA) introduced a family palliative care consultation fee to encourage family palliative care consultations; since its implementation, identifying which families require such consultations has become more important. In this study, the Taiwanese version of the Palliative Care Screening Tool (TW–PCST) was used to determine each patient’s degree of need for a family palliative care consultation.
Objective
This study analyzed factors associated with signing DNR consents. The results may inform family palliative care consultations for families in need, thereby achieving a higher DNR consent rate and promoting the effective use of medical resources, including time, labor, and funding.
Method
In this retrospective study, logistic regression analysis was conducted to determine which factors affected the DNR decisions of 2144 deceased patients (aged ≥ 20 years), whose records were collected from the Taipei City Hospital health information system from 1 January to 31 December 2018.
Results
Among the 1730 patients with a DNR consent, 1298 (75.03%) received family palliative care consultations. The correlation between DNR consent and family palliative care consultations was statistically significant (p < 0.001). Through logistic regression analysis, we determined that participation in family palliative care consultation, TW–PCST score, type of ward, and length of stay were significant variables associated with DNR consent.
Conclusions
This study determined that TW–PCST scores can be used as a measurement standard for the early identification of patients requiring family palliative care consultations. Family palliative care consultations provide opportunities for patients’ family members to participate in discussions about end-of-life care and DNR consent and provide patients and their families with accurate medical information regarding the end-of-life care decision-making process. The present results can serve as a reference to increase the proportion of patients willing to sign DNR consents and reduce the provision of ineffective life-prolonging medical treatment.

Complex surgery and optimal consent: A variety of opinions exist among healthcare professionals
Cillian Clancy, Niamh McCawley, John P. Burke, Deborah McNamara
The Surgeon, 29 December 2021
Abstract
Background
Establishing healthcare professional’s views on optimal consent in complex surgery could guide tailored consent policy, improving the process in challenging scenarios. To date, no studies have established if professionals of differing specialities agree on major aspects of consent in areas such as emergency surgery and cancer surgery.
Methods
An anonymous web based survey was distributed to a variety of disciplines in a tertiary referral centre. Questions regarding optimal methods and timing of consent in emergency and cancer surgery were posed. Comparative analyses of quantitative data were performed using chi-squared test.
Results
57 responses were received from doctors and nurses of varying disciplines. Differences were found between doctors of separate specialities and nurses in opinion of optimal timing of consent (p = 0.02), consent validity over time (p < 0.001) and the utility of introducing more specific consent policy (p = 0.01). Almost all respondents agreed that healthcare professionals have differing ideas of what consent is.
Conclusions
This study demonstrates differences in opinion regarding optimal consent for cancer and emergency surgery. Consideration should be given to developing consensus among healthcare professionals regarding what consent for complex surgery constitutes.