Evaluation of a Retrieval-Augmented Generation-Powered Chatbot for Pre-CT Informed Consent: a Prospective Comparative Study
Original Paper
Felix Busch, Lukas Kaibel, Hai Nguyen, Tristan Lemke, Sebastian Ziegelmayer, Markus Graf, Alexander W. Marka, Lukas Endrös, Philipp Prucker, Daniel Spitzl, Markus Mergen, Marcus R. Makowski, Keno K. Bressem, Sebastian Petzoldt, Lisa C. Adams, Tim Landgraf
Journal of Imaging Informatics in Medicine, 21 March 2025
Open Access
Abstract
This study aims to investigate the feasibility, usability, and effectiveness of a Retrieval-Augmented Generation (RAG)-powered Patient Information Assistant (PIA) chatbot for pre-CT information counseling compared to the standard physician consultation and informed consent process. This prospective comparative study included 86 patients scheduled for CT imaging between November and December 2024. Patients were randomly assigned to either the PIA group (n = 43), who received pre-CT information via the PIA chat app, or the control group (n = 43), with standard doctor-led consultation. Patient satisfaction, information clarity and comprehension, and concerns were assessed using six ten-point Likert-scale questions after information counseling with PIA or the doctor’s consultation. Additionally, consultation duration was measured, and PIA group patients were asked about their preference for pre-CT consultation, while two radiologists rated each PIA chat in five categories. Both groups reported similarly high ratings for information clarity (PIA: 8.64 ± 1.69; control: 8.86 ± 1.28; p = 0.82) and overall comprehension (PIA: 8.81 ± 1.40; control: 8.93 ± 1.61; p = 0.35). However, the doctor consultation group showed greater effectiveness in alleviating patient concerns (8.30 ± 2.63 versus 6.46 ± 3.29; p = 0.003). The PIA group demonstrated significantly shorter subsequent consultation times (median: 120 s [interquartile range (IQR): 100–140] versus 195 s [IQR: 170–220]; p = 0.04). Both radiologists rated overall quality, scientific and clinical evidence, clinical usefulness and relevance, consistency, and up-to-dateness of PIA high. The RAG-powered PIA effectively provided pre-CT information while significantly reducing physician consultation time. While both methods achieved comparable patient satisfaction and comprehension, physicians were more effective at addressing worries or concerns regarding the examination.

Demographic disparities in blood-borne-virus screening in two London Emergency Departments: a case for implied consent
Research Article
Cassandra Fairhead, Tristan J. Barber, Hajra Okhai, Russell Durkin, Jennifer Hart, Jessica Pinto, Alan Hunter, Douglas Macdonald, Fiona Burns
AIDS Care, 17 March 2025
Abstract
“Opt-out” Emergency Department (ED) blood-borne-virus screening enables early diagnosis, improving outcomes. Whereas some EDs encourage verbal reminders at blood draw, others emphasise “implied consent”. Associations between these approaches and screening equity have not been explored. This retrospective cohort evaluation quantified demographic disparities in screening in two EDs following “reminder model” screening rollout. Staff attitudes were explored, identifying screening barriers. ED attendees from July-October 2022 were identified electronically. Associations between age, sex, self-identified ethnicity, attendance time and admission status on screening were analysed using odds ratios (ORs). Twenty ED staff underwent semi-structured interviews. There were 33,388 eligible ED attendances (54.8% female; median age 53y). 58.9% of attendees received screening. In unadjusted analysis, the screening rate was higher in men (OR 1.05; 95%CI 1.00–1.10) and in non-admitted attendees. People of Black, Asian or Other ethnic backgrounds had lower rates compared to White ethnicity. Attendees between 5pm–11pm had lower rates and 11pm–9am higher rates compared to 9am–5pm. All associations persisted in multivariable models. Interviews revealed low confidence in follow-up discussion in attendees who opted out and a high workload precluding screening. Demographic disparities were seen in this “reminder model” context. Simplifying processes and emphasising implied consent may improve equitable screening.

Improving Consent in Trauma: Recall (ICIT: Recall): a multicentre study protocol of consent for hip fractures
Tony Feng, Andrew Ablett, Chloe E H Scott, Nick D Clement
Bone & Joint Open, 13 March 2025
Open Access
Abstract
Aims
This study investigates the effectiveness and adequacy of the informed consent process for patients undergoing hip fracture surgery. While informed consent is a legal and ethical responsibility, factors in the trauma setting can impair patients’ understanding and retention of information. This study seeks to evaluate patients’ recall of perioperative complications and explore their perceptions of the consent process.
Methods
A mixed-methods, multicentre cohort study will be conducted in the Southeast of Scotland. Adult patients with hip fractures will be recruited via consecutive sampling. An information recall questionnaire will be administered within 36 hours of admission to assess unprompted and prompted recall of complications. A subset of participants will then undergo a semi-structured qualitative interview postoperatively to explore their experiences and perceptions of the consent process. Data will be analyzed using a social constructivist grounded theory to assess their perceptions of consent. Ethical approval has been granted by the East of England Research Ethics Committee (reference 23/EE/0233).
Conclusion
Findings will be disseminated through peer-reviewed publications and presentations at national and international conferences. The study results will identify challenges in the consent process, particularly in how risks are communicated and understood. The data are expected to inform the development of information aids and enhance the ability of orthopaedic surgeons to provide comprehensive, patient-centred consent.

Obtaining Written Informed Consent for the Administration of Local Anesthetics in Dentistry in 2024, a 20-Year Follow-Up Study
Research Article
Daniel L. Orr, Zane P. Jenkins, Timothy M. Orr
Anesthesia Progress, 12 March 2025
Abstract
Objective
This study revisited data obtained in 2004 regarding whether dentists routinely obtain informed consent (IC) for the administration of local anesthetics and compared those findings with newer data obtained in 2024.
Methods
A previous survey from 2004 which utilized 3 questions including identification of provider type (generalist or specialist) and whether IC is always obtained for local anesthetic administration was replicated in 2024. While the 2004 survey was performed on paper, the 2024 survey was done via a brief oral interview. Both efforts were completed at the annual meetings of The American Dental Society of Anesthesiology (ADSA) in Las Vegas, NV.
Results
A total of 249 respondents opted to participate in the 2024 survey as compared with the 252 respondents from 2004. During the past 20 years, the number of dentists who reported always obtaining IC for the administration of local anesthetics appears to have increased significantly. A total of 196 (79%) of the 2024 participants reported always obtaining IC for local anesthesia compared with 158 (63%) in 2004. Except for dentists limiting their practice to anesthesiology, all other provider categories reported an increase in IC use from 2004 to 2024, and specialists still reported obtaining IC for local anesthesia more frequently than generalists.
Conclusion
The prevalence of including local anesthetic administration with the IC process is increasing in the profession. It is likely that generalists administer many more local anesthetics than specialists overall. The IC subject matter is too nuanced to recommend a single “yes or no” treatment plan as the standard of care for all clinical situations.

A Novel Strategy for Understanding What Patients Value Most in Informed Consent Before Surgery
Gillie Gabay, Attila Gere, Glenn Zemel, Howard Moskowitz
Healthcare, 28 February 2025
Open Access
Abstract
Background/Objectives
To map and analyze patient expectations regarding communication in IC and identify communication that both heightens anxiety in the IC process and reduces anxiety in the IC process before surgery.
Methods
Ethics approval was granted. A power analysis indicated a required sample of 90 patients. A conjoint-based experimental design was performed, post-discharge, overcoming typical biases of surveys.
Results
The sample comprised 104 patients who underwent surgery in the last year. Three verbal communication messages were perceived as significantly decreasing pre-operative anxiety for the total sample. Mathematical clustering yielded three distinct mindsets. Post hoc ANOVA indices indicated that the mindsets were significantly different. Patients belonging to each mindset differed from patients belonging to other mindsets in their expectations from the dialogue with surgeons to mitigate their anxiety. Mindset 1 (70% of the sample) comprised patients who expected information that was tailored to their specific situation. To feel safer, they needed to know that nothing unexpected would happen. Mindset 2 (13%) comprised patients who expected providers to talk with them about benefits and risks at the clinic, not at the hospital, and have a dialogue with them. Mindset 3 (17%) comprised patients who perceived a lack of information regarding the purpose of signing the informed consent and lack of sufficient time to thoroughly read the form or signing the form minutes before the procedure as elements that would heighten their anxiety.
Conclusions
Three verbal communication messages in the IC dialogue were thought to decrease pre-operative anxiety for all patients, as follows. “I want to make sure you read and understand the consent form entirely” “Everything is provided in clear and simple terms”. The surgeon says, “Let’s go over the entire form”.

The impact of inadequate disclosure and patient recall on the consent process in neurosurgery: A systematic literature review
Ashraf Elmahdi, David Smith
Surgeon, February 2025
Abstract
Background
The informed consent process in neurosurgery aims to uphold patient autonomy and provide comprehensive information for decision-making. However, gaps in communication and understanding between patients and surgeons persist. This systematic review examined the impact of consent on neurosurgical practice, exploring the effectiveness of different consent approaches.
Methods
A comprehensive search of databases and relevant sources identified twenty-eight studies for inclusion. Prospective and retrospective studies were assessed to examine the effect of consent on neurosurgical practice. Data collection and analysis involved independent reviewers assessing eligibility, study quality, and risk of bias. Findings from the included studies were used to write the review.
Main results
Randomized controlled trials specific to the impact of consent in neurosurgery needed to be included. Nevertheless, the reviewed twenty-nine studies revealed a significant risk of litigation due to inadequate information provision. Neurosurgeons’ adherence to the standard of competent peers was identified as crucial in bridging the gap between desired and actual patient-surgeon interactions.
Authors conclusions
This review underscores the need to address communication gaps between patients and surgeons within the informed consent process in neurosurgery. Neurosurgeons must strive to meet the standard of competent peers and implement effective consent strategies involving multiple modalities. Enhancing communication and patient comprehension can mitigate potential litigation risks, ensuring better patient-centred care and shared decision-making in neurosurgical practice.