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.

Role and Complexities of Informed Consent in Vascular Surgery
Editorial
Himanshu Verma
Indian Journal of Vascular and Endovascular Surgery, January – March 2025; 12(1)
Open Access
Introduction
   Informed consent is a cornerstone of ethical medical practice, emphasizing the patient’s right to autonomy and the alignment of medical care with their values and preferences. Over the past century, this principle has evolved from a procedural formality to an essential process enabling shared decision-making (SDM). Patients now actively participate in treatment decisions, weighing the risks, benefits, and alternatives of interventions to ensure their choices reflect personal goals and priorities.
While patient comprehension remains a critical element of informed consent, studies reveal significant gaps in understanding.[4] Patients often struggle to recall or fully grasp essential details, including diagnoses, procedural risks, benefits, and alternatives.[5,6] Consequently, informed consent has transitioned from being a mere legal safeguard to an interactive dialog fostering patient engagement and trust.[7,8] This editorial explores the nuances of informed consent, particularly within the context of vascular surgery, where challenges are multifaceted and deeply rooted in both medical complexity and patient perception.

Broad consent in the emergency department: a cross sectional study
Research
Antje Fischer-Rosinský, Larissa Eienbröker, Martin Möckel, Frank Hanses, Felix Patricius Hans, Sebastian Wolfrum, Johannes Drepper, Philipp Heinrich, Anna Slagman
Archives of Public Health volume, 18 February 2025
Open access
Abstract
Background
The Medical Informatics Initiative (MII) introduced a broad consent form (MII-BC) encompassing clinical, insurance, and biomaterial data, along with re-contacting options. In the emergency department (ED), outpatient and inpatient patients of all illnesses and severity could be reached early in their treatment course. The BC-ED (Broad Consent in the Emergency Department) project uniquely investigated the implementation of MII-BC in EDs, exploring feasibility, selection bias and patients’ perceptions of voluntariness, information recall, motivation, and satisfaction.
Methods
The BC-ED project involving four university hospital EDs in Germany, is part of CODEX+ (Collaborative Data Exchange and Usage), an initiative within the Network University Medicine (NUM). To minimize selection bias, a systematic sampling approach (every 5th/30th patient) was applied, with patient recruitment and consent processes adapted to local conditions and therefore varying among sites. Data collection included patient questionnaires, surveys completed by study nurses, and routine clinical data. Analysis was conducted descriptively using SPSS.
Results
Of 1,138 patients approached, 553 (48.6%) were capable of giving consent. Of 353 patients who could not consent, primary reasons included language barriers (35.4%) and inability to grasp study details (21.5%). Of all eligible patients, 3.3% could not be contacted. Of 535 (47.0%) patients able to consent and contacted, 313 consented to the MII-BC. Resulting in a consent rate of 27.5% corresponding to the baseline population and 58.5% of those contacted. Motivations for consenting were general support for research (85.3%) and the desire to help future patients (78.2%). Patients generally reported a high level of understanding and satisfaction with the consent process, reporting comprehensive understanding of scientific data use (89.8%) and associated risks (82.2%). However, discrepancies were noted between consented options and patient recall.
Conclusions
This study is the first to investigate the implementation of the MII-BC in the challenging ED environment. With a consent rate of 27.5% total baseline population and 58.5% of those contacted, it demonstrates that patients were able and willing to participate in research. Reasons for non-consent were barriers like language and medical conditions. Strategies to address these barriers are crucial for inclusivity. Although patients generally understood the consent process, discrepancies in recall highlight the need for improved comprehension strategies.

Advance Consent for Interventional Radiology Procedures: Quality Improvement Project
Rohan Shankarghatta, Alexandra Garnett
The Physician, 17 February 2025
Abstract
Background
Advance consent is crucial for patients undergoing Interventional radiology (IR) procedures with potential serious harm. Two previous audits at our hospital revealed issues with obtaining consent before the day of the procedure, leading to the implementation of a consent clinic. Subsequently, a new electronic patient record (EPR) system was introduced. This third audit cycle assessed whether these changes improved the advance consent rates for vascular IR procedures.
Method
We retrospectively reviewed 53 patients who underwent vascular IR procedures in January 2023, noting whether each procedure was inpatient or outpatient, urgent or elective, and the procedure type. These results were compared with previous cycles to evaluate adherence to consent standards.
Results
Among the 53 patients, there was an even split between inpatient and outpatient procedures, as well as between urgent and elective procedures. 27 patients underwent lower limb angiogram/angioplasty, 19 had fistula work, and 7 underwent other procedures. 77% of patients consented in advance or had the consent process initiated beforehand.
Conclusion
An improvement in advance consent rates was noted compared to previous cycles (14% → 63% → 77%) following the implementation of consent clinics and the new EPR system. However, 33% of patients, primarily those undergoing fistula work, still consented on the day of the procedure. This audit highlights the benefit of the new EPR system and the need to continue consent clinics, emphasizing the importance of advance consent, especially for fistula procedures.

Is informed consent correctly obtained for vaccinations?
Dhriti Jagadish, Nathaniel Mamo, Felicia Pasadyn, Arthur Caplan
Human Vaccines & Immunotherapeutics, 16 February 2025
Abstract
Informed consent is an integral tenet of medical ethics. However, the United States lacks a standardized consent process for immunizations, with states and private companies instead reliant on Vaccine Information Statements (VISs) introduced by the 1986 National Childhood Vaccine Injury Act. VISs, rather than being developed with patient autonomy in mind, were a response to excessive vaccine injury litigation and resulting vaccine supply shortages. VISs do not provide meaningful information disclosures, with its producer – the Centers for Disease Control and Prevention – itself admitting that VISs should not be mistaken for informed consent forms. In its content, the VIS is too complex in its readability, does not situate immunization in a public health context, and does not present all alternatives. VIS delivery is also inadequate, with limited time given for patients to digest vaccine information and no documentation required to ensure that VISs were presented at all. Simply put, VISs do little to spark deliberation and increase vaccine confidence. This article recommends minor improvements to VIS content, delivery, and accountability mechanisms to ensure distribution. The authors argue that these patient-provider moments – for patients to better understand their health, the threat of disease, and the weight of their contribution to the public – should not be squandered.

Consent: risk assessment, risk communication and shared decision making
Catherine Rimmer
Surgery, 10 February 2025
Abstract
The consent process is the foundation of the modern doctor–patient relationship, and can present a significant challenge to doctors. The consent process can be complex, and often involves the interaction of many different factors, including ethical and legal considerations. A shared decision-making process allows for full consideration of the treatment options available, and takes into account individual patients’ values and preferences. Ensuring that the patient is fully informed requires a thorough understanding of the risks of an intervention for that particular patient; therefore, individualized risk assessment is of fundamental importance. Using a combination of individual patient information, formal investigations and population data gives the most complete assessment of risk. Communicating that risk information to patients is key, and the doctor should always use clear language and avoid bias. The use of visual aids and information leaflets and the avoidance of vague language and complex statistical terms will all help the patient to develop a more complete understanding of the risks they face.