Informed Consent Practices for Publication of Patient Images in Dermatology Journals
Toluwani Taiwo, Bianca Obiakor, Sarah McClung, Kanade Shinkai
Journal of the American Academy of Dermatology, September 2024
Abstract
Clinical images play a crucial role in dermatology for patient care and education. The lack of standardized informed consent for publishing images in dermatology journals creates ambiguity for both patients and authors. This cross-sectional study examined informed consent practices in the top 50 dermatology journals based on the 2022 Clarivate Journal Impact Factor ranking. We reviewed journal websites and patient consent forms during June 28 to July 24, 2023 using an author-created checklist compiled from available best practices for image publication. Approximately 90% of journals specified image consent requirements, though there was notable variability in criteria related to image modification, safeguards for anonymity (e.g., eyebars, cropping, blurring), and the definition of identifiable features. Examples of identifiable features (e.g., tattoos, birthmarks, jewelry) were provided in 14% of journals. Despite the prevalence of social media presence among journals (70%), only 6% acknowledged potential risks associated with image dissemination on these platforms. While around 52% of journals presented journal or publisher-specific consent forms, inclusion of essential components, guided by International Committee of Medical Journal Editors guidelines, varied. Notably, 77% of these forms explicitly addressed how images could be disseminated beyond print publication, with 39% detailing patients’ ability to revoke consent, and 19% considering the possibility of patients benefiting financially from publication. Our assessment revealed inconsistencies in image consent practices across journals and their associated consent forms for patients. These findings highlight important opportunities for improvement, including uniform consent guidelines and standardized definitions of identifiable features to protect patient privacy in medical image publication.

Surgical Options for Breast Cancer and Consent Guidelines for Indigenous Women
Book Chapter
Jennifer Erdrich, Felina Cordova-Marks, Amanda Bruegl
Indigenous and Tribal Peoples and Cancer, 31 August 2024 [Springer]
Open Access
Key Points

• Women diagnosed with breast cancer and preparing for surgery can choose between breast-conserving therapy (BCT) and mastectomy. Breast cancer survival for BCT and mastectomy are equivalent.
• Surgical patterns show that American Indian/Alaska Native (AI/AN) women in the United States have more mastectomy and less breast-conserving therapy for early-stage breast cancer compared to non-Hispanic White (NHW) women.
• For all women, regardless of race, informed consent for lumpectomy vs. mastectomy is a complex, time-intensive process entailing comprehensive counseling. Additional historical and cultural considerations must inform consent guidelines for Indigenous women preparing for breast cancer surgery.
• We propose innovative solutions to overcome the challenges that limit Indigenous women’s access to their preferred surgical choice.

Abstract
    Breast-conserving therapy (BCT) consists of lumpectomy followed by radiation. A lumpectomy removes the tumor and surrounding rim of normal breast tissue, leaving most of the breast volume and shape intact. A mastectomy removes the entirety of the breast tissue. Randomized trials with long-term follow-up demonstrate that, regardless of the stage of disease, survival is equivalent for both treatment options. While the risk of recurrence with lumpectomy alone is higher, modern multidisciplinary care combining lumpectomy with radiation and various forms of systemic therapy achieves a similar low risk of recurrence, allowing clinicians to offer BCT or mastectomy as equally safe standard care options. This establishes a surgical choice that is highly personal and should be individualized to consider multiple unique factors, including age, family history, hereditary gene mutations, size of the tumor relative to total breast volume, ability to complete multimodality breast care and surveillance, future plans regarding fertility and lactation, and overall best outcome for the individual’s body-image, lifestyle, and peace of mind.
BCT consistently shows decreased surgical complications, decreased pain, faster recovery, more favorable cosmetics, and better-preserved sexuality and body image. This is not to say that it is the best choice for every woman. BCT is contraindicated for women with inflammatory breast cancer. For some, mastectomy is preferred for personal reasons, even with a full understanding of equivalent survival following BCT. Provided the patient is well-informed and has worked with her clinical team to ensure her decisions are safe, she should be supported in her surgical choice.

Ethical Issues and Consent in Oral and Maxillofacial Surgery
Book Chapter
Ahmad Nazari
Handbook of Oral and Maxillofacial Surgery and Implantology, 13 April 2024 [Springer]
Abstract
Oral and maxillofacial surgery, encompassing a wide range of procedures from corrective jaw surgery to facial trauma repair, sits at a complex intersection of aesthetics, functionality, and patient well-being. This specialty, therefore, faces unique ethical challenges, particularly in the realm of patient consent. Obtaining informed consent is not merely a legal formality but a fundamental ethical principle that honors patient autonomy and ensures shared decision-making. Surgeons must navigate these waters with care, ensuring patients understand the potential risks, benefits, and alternatives of proposed treatments. This chapter delves into the ethical nuances of consent in oral and maxillofacial surgery, exploring how surgeons can foster an environment of trust and transparency. It highlights the importance of clear communication, patient education, and the ethical considerations necessary to guide both routine and complex surgical decisions.

Deferred Consent in Emergency Trauma Research: A Qualitative Study Assessing the Healthcare Professional’s Opinions
Injury, 15 August 2024
Zynab Noori, Niek J. Vianen, Esther M.M. Van Lieshout, Erwin J.O. Kompanje, Iscander M. Maissan, Michiel H.J. Verhofstad, Mark G. Van Vledder
Abstract
Introduction
Severely injured patients are often incapacitated to provide informed consent for clinical studies. Deferred consent could facilitate unbiased enrollment in studies involving these patients. Little is known about how healthcare professionals (HCPs) perceive deferred consent and how this impacts patient enrollment. The aim of this study was to identify factors that could influence HCPs decision-making during recruitment of patients for interventional studies in (pre)hospital emergency trauma research.
Methods
This was a qualitative study in which physicians and nurses working in prehospital or in-hospital care were interviewed using a semi-structured interview guide. Interviews were audio-recorded, transcribed, and analyzed according to thematic analysis as described by Braun and Clarke.
Results
Ten semi-structured interviews were conducted with six physicians and four nurses. Eight themes were identified as being relevant consent related factors influencing HCPs’ decision-making during patient recruitment in studies using deferred consent: 1) HCPs’ lack of knowledge; 2) Patients’ and proxies’ inability to be informed; 3) Practical (im)possibilities for informed consent; 4) Nature of intervention; 5) HCPs’ personal beliefs; 6) Importance of emergency care research; 7) HCPs’ trust in legal base; and 8) Communication and collaboration.
Conclusions
Eight consent-related factors influencing HCPs’ decision making were identified. Insufficient knowledge about consent procedures among HCPs leads to significant negative attitudes towards deferred consent.

Follow Informed Patient Consent in Clinical Teaching in Order to Achieve a Truly Patient-Centered Approach
Research Article
Hongnan Ye
Journal of Patient Experience, 14 August 2024
Open Access
Abstract
Patient- and disease-focused clinical teaching is considered the cornerstone of medical education. Current clinical teaching is increasingly taking place in outpatient settings, but this can cause discomfort to patients. Although many professional organizations have developed a set of ethical considerations in response to this issue to use these considerations to guide clinics in their outpatient procedures, these guidelines are not well adhered to in outpatient practice. My experience as an eczema patient in a dermatology outpatient is good evidence of this. In my opinion, there is nothing inherently wrong with the pedagogy of medical students observing clinical interactions in outpatient settings; the real problem lies in not informing the patient of the medical student’s presence or allowing the patient to exercise his or her right of refusal. Therefore, the following recommendations are made: First, academic medical centers should provide regular training to doctors and medical students to ensure that they are fully aware of what is contained in the ethical guidelines established by the professional organizations and that they recognize the importance of adhering to these guidelines in clinical practice. Second, each clinical teaching activity should have the informed consent of the patient and be based on the patient’s wishes. Finally, it is recommended that hospitals establish appropriate evaluation mechanisms to assess doctors’ compliance with the ethical guidelines and provide continuing education and training for doctors and medical students who fail to comply.

Consent for interventions during childbirth: A national population-based study
Clinical Article
Marianne Jacques, Anne Alice Chantry, Anne Evrard, Nathalie Lelong, Camille Le Ray, the ENP2021 Study Group
Gynecology & Obstetrics, 2 August 2024
Open Access
Abstract
Objective
To assess the frequency and determinants of medical interventions during childbirth without women’s consent at the population level.
Methods
The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition.
Results
Women reporting failure to seek consent were 44.7% (CI: 42.6–47.0) for oxytocin administration, 60.2% (CI: 55.4–65.0) for episiotomy, and 36.6% (CI: 33.3–40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06–1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68–0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11–1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13–1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28–1.96).
Conclusion
Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women’s involvement in decision making during childbirth.

Enhancing Patient Understanding of Cardiac Catheterisation Prior to Procedural Consent
J. Reynolds, R. Newcombe, G. Armstrong, S. El-Jack, T. Wijohn
Heart, Lung and Circulation, August 2024
Abstract
Background
People with reduced health literacy are at higher risk of not sufficiently understanding informed consent prior to procedures. Approximately 44% of adults read at or below the age of an average 12-13-year-old, indicating they may struggle to understand basic health information during the consent process. This is magnified in indigenous peoples, older adults and those with English as a second language in both countries.
Methods
We designed a procedural graphic comic booklet to be shared prior to the consent process, aiming to increase understanding in all patient groups. Pilot research on patients’ understanding of basic probability was conducted using non-medical questions confirmed poor understanding of risk. The comic booklet was developed with patient and health literacy group input and subjected to several cycles of feedback to reach the final version utilised in our audit.
Results
We audited patient and staff perceptions of the graphic comic booklet to the commonly used Heart Foundation information booklet. In 15 patients and 12 health-workers, the graphic comic booklet format was felt to be more succinct and understandable and was preferred by the majority of respondents. A small group preferred more detailed information.
Discussion
The use of a graphic comic booklet can therefore be an important educational tool, aiding patient understanding of procedures prior to the consent process. We intend to use it in addition to the current pre-angiography education provided to patients.

Informed consent in neurosurgery – Evaluation of current practice and implementation of future strategies
Francesca Colombo, Ross McLeod, Rohit Ravindranath Nambiar, Helen Maye, Sam Dickens, K Joshi George
Surgical Neurology International, 19 July 2024
Abstract
Background
In recent times, clinical negligence claims against National Health Service hospitals have doubled, with 8% of claims being made due to “failure to warn/informed consent.” This study aimed to assess the current compliance of the neurosurgical division within a large tertiary neuroscience center with the national legal framework and professional guidelines around the issue of surgical consent and to develop strategies to improve the consent process.
Methods
Electronic patient records (EPR) were accessed to collect demographic data and information regarding the surgical procedures. Telephone questionnaires were carried out. Neurosurgical registrars were interviewed. The author met with the trust’s Legal team, the neuropsychology lead, and the trust’s consent lead.
Results
Fifty-eight patients were included in the analysis. Of the respondents to the questionnaire, 98% felt that they were adequately informed during the consent process. When consenting patients, all registrars felt that they explained the reason for the procedure, detailed benefits, and major risks, including uncommon and rare risks. However, 50% admitted to not specifically discussing the postoperative recovery time or alternatives. Only 15% admitted to documenting on the EPR or through a letter to the patient’s General Practitioner.
Conclusion
Informed consent is a delicate moment of communication between a clinician and the patient. Regular training and good communication skills help staff to focus on the most relevant aspects of consent, which should be delivered in an appropriate environment and with family support. Audio-visual aids can support the process but do not replace good communication.

Do Interns Learn On-The-Job How to Obtain Proper Informed Consent for Surgical Procedures?
Original Reports
Michael Lamb, John M. Woodward, Brian Quaranto, Bobbie Ann Adair White, Linda M. Harris, James K. Lukan, Jeffrey Brewer, Steven D. Schwaitzberg, Clairice A. Cooper
Journal of Surgical Education, 17 July 2024
Abstract
Objective
Obtaining surgical informed consent (SIC) is a critical skill most residents are expected to learn “on-the-job.” This study sought to quantify the effect of 1 year of clinical experience on performance obtaining SIC in the absence of formal informed consent education.
Design
In this case-control cohort study, PGY1 and PGY2 surgical residents in an academic program were surveyed regarding their experiences and confidence in obtaining SIC; then assessed obtaining informed consent for a right hemicolectomy from a standardized patient.
Setting
Single academic general surgery residency program in Buffalo, NY.
Participants
Ten PGY1 and eight PGY2 general surgery residents were included in the study, after excluding residents with additional years of training.
Results
PGY2 residents had significantly more experience obtaining SIC compared to PGY1 residents (median response: “>50” vs “between 6 and 15,” p = 0.001), however there was no difference in self-reported confidence in ability obtaining SIC (mean 3.2/5 in PGY1 vs 3.4/5 in PGY2, p = 0.61), self-reported knowledge of SIC (mean 3.1/5 in PGY1 vs 3.6/5 in PGY2, p = 0.15), performance on a test regarding SIC (mean score 9.0/20, SD 3.9 for PGY1 vs mean score 9.6/20, SD 3.5, t = 0.387, p = 0.739) or performance during a standardized patient interview (mean 11.2/20, SD 2.78 for PGY1 vs mean 11.4/20, SD 1.51 for PGY2, p = 0.87). In the interviews all residents addressed general risks (bleeding/infection), however both groups performed worse in addressing procedure-specific risks including anastomotic leak as risk for hemicolectomy.
Conclusions
A year of clinical training between PGY1 to PGY2 did not improve performance in obtaining surgical informed consent when lacking formal education, despite self-confidence in their ability. A curriculum covering the content, delivery and assessment of informed consent should be initiated for residents upon arrival to surgical training.

Improving Clinical Communication: a qualitative study on the Informed Consent
Isabel García-Izquierdo, Begoña Bellés-Fortuño
Revista De Lingüística Y Lenguas Aplicadas, 8 July 2024
Abstract
In the context of the Patient-Centred Care paradigm (Epstein et al., 2005; Suojanen et al., 2012) and the shift toward the psychobiological model (Dean & Street, 2015; Muñoz & García-Izquierdo, 2020), there is a growing demand for the patient to be an active agent in the management of their health. Clinical communication should be conveyed accurately and empathetically (Bellés Fortuño & García-Izquierdo, forthcoming), especially in complex legal genres such as the Informed Consent (IC). The research carried out by the Gentt research group up-to-date has revealed that there is no specific monitoring with the use of IC protocols in clinical practice. In this paper, we present the results of a qualitative pilot study with a group of practitioners from the Valencian Community (Spain). A focus group was conducted where the articulation of communication with patients was analyzed. The study tries to define the practical insights of using the IC to draw conclusions that can improve clinical communication. Results show that MPs generally consider that the IC process needs improvement, especially when considering closeness with patients to enhance communication.