Consent for toxicology testing during pregnancy: a qualitative study of patient and clinician perspectives
Leah N. Schwartz, Ellis J. Yeo, Molly R. Siegel, Davida M. Schiff, Sarah N. Bernstein
American Journal of Obstetrics & Gynecology, 1 January 2023
Abstract
Objective
Although state, federal, and professional guidelines stipulate the need for informed consent prior to toxicology testing during pregnancy, consent is often inadequately obtained. Our objective was to explore patient and clinician experiences obtaining consent for toxicology testing during pregnancy.
Study Design
Semi-structured qualitative interviews were conducted with 25 obstetric clinicians and 10 patients who had toxicology testing performed during their delivery hospitalization at two institutions from December 2021-June 2022. Interviews assessed clinical decision-making, perceptions of testing utility, and consent and communication practices. Using a modified grounded theory approach, transcripts were double-coded and analyzed in Dedoose.
Results
When obtaining consent for toxicology testing, clinicians reported they routinely discuss testing indication but rarely address the patient’s right to refuse and the consequences of a positive result, both of which patients identified as important components of consent. Patients expressed discomfort asking questions during the consent process and an inability to decline testing, even among those who were told they could do so. The most frequently cited barriers by clinicians included limited experience with obtaining consent for toxicology testing, inability to explain the risks and benefits of testing, and a perceived erosion of the patient-clinician relationship. In contrast, clinicians reported increased comfort obtaining consent when testing indications were clearly outlined in a hospital policy they could reference.
Conclusion
Obstetric clinicians felt unprepared to obtain informed consent for perinatal toxicology testing, leaving patients without information necessary to make informed choices about their care. Additional provider education emphasizing shared decision-making and an improved understanding of the use of testing by child protective services are needed to adequately protect the rights of birthing persons.
Month: February 2023
Level of Patients’ Education and Knowledge About Informed Consent of Cesarean Section in Females Undergoing Planned Cesarean Section
Level of Patients’ Education and Knowledge About Informed Consent of Cesarean Section in Females Undergoing Planned Cesarean Section
Robina Zahoor, Rabia, Adila Ashraf, Hania Zafar, Shazia Abid
Journal of Akhtar Saeed Medical & Dental College, July-September 2022; 4(3)
Open Access
Abstract
Background
The consent-providing individual must not only have the appropriate mental ability but also have all of the required knowledge to give consent correctly. The patient must provide consent to accept or decline any treatment or examination. The study aimed to find the level of patients’ education and knowledge about informed consent of cesarean section in females undergoing planned cesarean section
Material and Methods
This study was cross-sectional and carried out at Unit I, Department of Obstetrics and Gynecology, Sir Gangs Ram Hospital, Lahore for a duration of six months after approval of synopsis from January 2022 to June 2022. All the enrolled patients were asked about the informed consent of cesarean section before undergoing cesarean section and their knowledge about informed consent was noted. The Female education about informed consent was obtained as per operational definition by the researcher herself after the procedure. Data analysis was done through SPSS version 21 software.
Results
A total of 100 cases were enrolled in the current study. Level of adequate knowledge about informed consent of cesarean section was recorded in 74 (74%) of the cases whereas adequate knowledge was not recorded in 26 (26%) cases. Level of adequate education about informed consent of cesarean section was recorded in 9 (9%) of the cases whereas adequate education was not recorded in 91 (91%) cases.
Conclusion
Our study concluded that a high number of patients have an adequate level of knowledge about informed consent for cesarean section in females undergoing planned cesarean section while the level of adequate education was very low.
Editor’s note: The Journal of Akhtar Saeed Medical & Dental College is in Lahore.
Dignity and Respect: Why Therapeutic Assent Matters
Dignity and Respect: Why Therapeutic Assent Matters
Discussion and Review Paper
Jaime Flowers, Jillian Dawes
Behavior Analysis in Practice, 19 January 2023
Abstract
During therapeutic treatment and research in psychology and related fields, informed consent by the client or participant is required when they are over the age of 18; assent is required when a client or participant is under the age of 18 or a conserved adult. During both research and treatment, behavior analysts often work with neurodiverse individuals who have language deficits, and these clients may require unique assent procedures. This article will outline reasons behavior-analytic research and therapy require field-specific assent procedures. Furthermore, the goals of research and therapy are different and therefore assent may need to differ as well. This article will also argue that therapeutic assent during behavior-analytic treatment requires a unique set of guidelines and procedures that may differ from the behavior-analytic research.
Evaluation of consent to link Twitter data to survey data
Evaluation of consent to link Twitter data to survey data
Zeina Mneimneh
Journal of the Royal Statistical Society, December 2022; 185(S2) pp 364-386
Abstract
This study presents an initial framework describing factors that could affect respondents’ decisions to link their survey data with their public Twitter data. It also investigates two types of factors, those related to the individual and to the design of the consent request. Individual‐level factors include respondents’ attitudes towards helpful behaviours, privacy concerns and social media engagement patterns. The design factor focuses on the position of the consent request within the interview. These investigations were conducted using data that was collected from a web survey on a sample of Twitter users selected from an adult online probability panel in the United States. The sample was randomly divided into two groups, those who received the consent to link request at the beginning of the survey, and others who received the request towards the end of the survey. Privacy concerns, measures of social media engagement and consent request placement were all found to be related to consent to link. The findings have important implications for designing future studies that aim at linking social media data with survey data.
Metadiscourse in Informed Consent: Reflections for Improving Writing and Translation
Metadiscourse in Informed Consent: Reflections for Improving Writing and Translation
Isabel García-Izquierdo
GEMA Online Journal of Language Studies, November 2022, 22(4) pp 161-185
Abstract
Metadiscourse has been one of the most prolific areas of research in the field of applied linguistics in recent years. It is understood as the way we use language to connect with our audience, which is the result of integrating propositional content and interpersonal factors (Hyland, 2017). In this paper we will analyse Metadiscourse in one of the most complex medical-legal genres: informed consent (IC). Drawing on a small comparable bilingual corpus of texts belonging to this genre for surgery in Spanish and English, the paper aims to analyse (by using Sketch Engine tools) how metadiscursive elements are evident in written IC documents, and to reflect on what aspects need to be taken into account in order to improve the way these documents are written and translated in the future. The Key findings are a low frequency of Interactive resources and a more significant presence of Interactional resources in both corpora. However, boosters are almost non-existent, because a large part of the texts belonging to this genre incorporate pre-established formulaic text. Most of the content is related to the procedures requiring consent and their possible consequences, so the sender almost always tends to avoid universal statements and to display a certain reserve in case predictions are not fulfilled. The conclusion is threefold: some metadiscursive elements in the IC manifest themselves in a different way from other medical genres; a more frequent use of some of the interactive and interactional resources could lead to a better understanding; and finally, it would be important to include the analysis of these metadiscursive elements in the training of future medical writers and translators.
Center for Informed Consent Integrity 