Assessing Adult Patients’ Understandings of Secondary Malignancy Risk Terms in Radiation Therapy Consent
N.Vartanian, M.Wilson, R.P.Ermoian
International Journal of Radiation Oncology*Biology*Physics, 1 November 2022; 114(3) pp e500-e501
Abstract
Purpose/Objective(s)
Informed consent is an essential component of cancer care. The terms “second tumors” or “secondary tumors” are sometimes used in radiation therapy consent. Their incidences are sometimes described as “rare,” although vary greatly from nearly negligible in patients treated with palliative intent, to 20% in young patients undergoing myeloablative total body irradiation. We evaluated whether patients without prior knowledge of radiation therapy interpret the terms in a way consistent with physician intent.
Materials/Methods
We screened 164 adult subjects who did not require medical interpreters at a university-affiliated family medicine clinic, excluding cancer patients and those with any prior knowledge of or experience with radiation treatment. One hundred subjects were eligible for and completed a 12-question multiple choice questionnaire, which assessed their understanding of the term “secondary tumor” or “second tumor”, and how they would interpret the terms “small chance” or “rare” in the context of a “bad side effect.”
Results
Twenty-nine percent of subjects correctly identified that “secondary tumors” referred to new and different tumors caused by treatment. Forty-nine percent thought the term referred to their original tumor recurring, and 22% thought the term referred to new and different tumors not caused by radiation therapy. Subjects with college degrees were not more likely to choose the correct answer than subjects without college degrees p=0.63. College degree status was not available for 5 subjects. Given choices between 1:10, 1:100, 1:1000, and 1:100,000, subjects associated “rare” with 1:1000 or 1:100,000 82% of the time. The term “small chance” was associated with 1:1000 or 1:100,000 59% of the time.
Conclusion
Adult non-cancer patients have a demonstrably different understanding than radiation oncologists of the terms “second tumor” or “secondary tumor.” Additionally, patient understanding of the terms “rare” or “small chance” varies from secondary malignancy incidences in many clinical scenarios. Radiation oncologists should use clearer terms for secondary malignancies and their incidence.

Survey of Informed Consent Procedures in Urology
Juliana Kim, Arnav Srivastava, Alexandra Tabakin, Eric A Singer
Journal of the American College of Surgeons, November 2022; 235(5)
Abstract
Introduction
The American Urological Association and American College of Surgeons codes of professionalism require surgeons to disclose the specific roles and responsibilities of trainees to patients during the informed consent process. This study analyzes how these requirements are met by urology training programs.
Method
An anonymous electronic survey was distributed to the program directors (PDs) of the 143 ACGME urology residency programs in the US in 2021. Responses were procured during 3 months. Information was collected regarding program demographics, aspects of the program’s consent process, and the disclosure of the role and participation of residents to patients.
Result
Of 143 distributed surveys, 30.0% (n = 43) received a response. Of responding PDs, 67.4% reported that attending physicians lead the consent process. The topics covered during consent discussion include possible complications (25.1%), expected recovery time (22.8%), length of the surgery (22.2%), the people involved (18.0%), and their specific roles (7.2%). Of PDs, 48.8% and 87.8% of do not explicitly discuss trainee involvement or when a resident performs the majority of the case, respectively (Figure). Of PDs, 78.8% do not communicate medical student involvement. Of PDs, 73.2% reported having a patient decline participation of a trainee after describing their role.
Conclusion
Despite the American Urological Association and American College of Surgeons codes of professionalism, many urologists involved in the training of residents may not disclose resident participation in surgery to patients. Further discussions are needed to explore how to better balance resident education while strengthening the informed consent process.

How I Learned is How I Teach – Perspectives on How Faculty Surgeons Approach Informed Consent Education
Erin M. White, Andrew C. Esposito, Vadim Kurbatov, Xujun Wang, Michael G. Caty, Maxwell Laurans, Peter S. Yoo
Journal of Surgical Education, 15 October 2022
Abstract
Objective
To understand the variability of surgical attending experience and perspectives regarding informed consent and how it impacts resident education
Design
A novel survey was distributed electronically to explore faculty surgeon’s personal learning experience, knowledge, clinical practice, teaching preferences and beliefs regarding informed consent. Chi-square and Kruskal-Wallis testing was performed to look for associations and a cluster analysis was performed to elucidate additional patterns among.
Setting
Single, tertiary, university-affiliated health care system (Yale New Haven Health in Connecticut), including 6 teaching hospitals.
Participants
Clinical faculty within the Department of Surgery.
Results
A total of 85 surgeons responded (49% response rate), representing 17 specialties, both private practice and university and/or hospital-employed, with a range of years in practice. Across all ages, specialties, the most common method for both learning (86%) and teaching (82%) informed consent was observation of the attending. Respondents who stated they learned by observing attendings were more likely to report that they teach by having trainees observe them (OR 8.5, 95% CI 1.3-56.5) and participants who recalled learning by having attendings observe them were more likely to observe their trainees (OR 4.1, 95% CI 1.5-11.2).Cluster analysis revealed 5 different attending phenotypes with significant heterogeneity between groups. A cluster of younger attendings reported the least diverse learning experience and high levels of concern for legal liability and resident competency. They engaged in few strategies for teaching residents. By comparison, the cluster that reported the most diverse learning experience also reported the richest diversity of teaching strategies to residents but rarely allowed residents to perform consent with their patients. Meanwhile, 2 other cluster provided a more balanced experience with some opportunities for practice with patients and some diversity of teaching– these clusters, respectively, consist of older, experienced general surgeons and surgeons in trauma and/or critical care.
Conclusions
Surgeon’s demographics, personal experiences, and specialty appear to significantly influence their teaching styles and the educational experience residents receive regarding informed consent.

Informed consent for psychotherapy: Ethical illusion or clinical reality? A survey about psychotherapists’ attitudes and practices in Germany
Leonie Gerke, Ann-Katrin Meyrose, Yvonne Nestoriuc
Clinical Psychology and Psychotherapy, 10 October 2022
Abstract
Objective
This study aimed to assess clinicians’ attitudes and their current clinical practices regarding informed consent for psychotherapy.
Method
A convenience sample of N = 530 clinicians in Germany (n = 418 licensed psychotherapists and n = 112 postgraduate psychotherapy trainees) took part in an online survey.
Results
Most clinicians (84%) reported obtaining informed consent for psychotherapy in their daily routine. However, many psychotherapists felt unsure about satisfactorily fulfilling the legal (63%) and ethical obligations (52%). The two most frequently reported components of information disclosure related to explaining the terms and conditions of psychotherapy (96%) and the psychotherapeutic approach (91%). Providing information about mechanisms of psychotherapy (33%) and the role of expectations (30%) were least practiced. One in five psychotherapists reported not informing clients about potential risks and side effects. A considerable proportion reported concern about inducing anxiety in patients by disclosing information about risks and side effects (52%).
Conclusions
Although obtaining informed consent for psychotherapy seems to be the rule rather than the exception in clinical practice, the quality of its implementation in terms of legal, ethical and clinical demands remains questionable. Training psychotherapists in providing comprehensive informed consent enables informed decision-making and might have a positive influence on treatment expectations and outcomes.