The psychoanalytic frame and the consent situation: the child patient’s position in the publication dilemma
Research Article
Michael Garcia
Journal of Child Psychotherapy, 12 May 2023
Abstract
The author explores the current dilemma regarding consent standards for the publication of child patient clinical material, and the psychic impact on the child when seeking permission to publish. It is proposed that a psychoanalytic view creates an additional dimension to the more universal ethic of ‘do no harm’, requiring clinicians to consider the unconscious experience of the patient as the core of the matter. The term consent situation is introduced to describe the way in which providing a draft of the clinician’s writing about the patient’s experience in treatment, and then asking the patient and family for permission to publish it, subjects them to external realities of an oedipal nature, compromising the frame around the treatment, and the vital cycle of the containing function in the treatment. The frame could potentially be compromised from the beginning in the form of a leaky container, during the treatment as a betrayal of the frame, or after the treatment has ended as an intrusion into the containing object. The author shows how this is a burden to all young patients that could be collectively carried by the professional community, by using creative modifications to systems of professional development and publishing.

Medical staff’s sense of awareness of informed consent for adolescent cancer patients and the need for decision-making support practiced from the perspective of trauma-informed approach
Research
Kyoko Tanaka, Maoko Hayakawa, Makiko Mori, Naoko Maeda, Masako Nagata, Keizo Horibe
BMC Medical Ethics, 6 May 2023; 24(28)
Open Access
Abstract
It has not been established how to assess children’s and adolescents’ decision-making capacity (DMC) and there has been little discussion on the way their decision-making (DM). The purpose of this study was to examine actual situation and factors related to difficulties in explaining their disease to adolescent cancer patients or obtaining informed consent (IC). The cross-sectional questionnaire survey was conducted. Physicians who have been treating adolescent cancer patients for at least five years answered a self-administered questionnaire uniquely developed about clinical difficulties in explaining, IC and factors related patient’s refusal of medical treatment (RMT). Descriptive statistics for each item and a polychoric correlation analysis of the problems and factors related to the explanation were conducted. As a result, fifty-six physicians were participated (rate of return: 39%). Explaining the disease and treatment to patients (83.9%), IC to patients (80.4%), and explaining the disease and treatment to parents (78.6%) was particularly problematic. Difficulties to provide support related with patient’s refusal of medical treatment and to explain disease and treatment for patient and parents were related to difficulties obtaining IC for the patient. Conclusion: There are clinically difficult to explain for the patient or parents and to obtain IC for the patient. It is necessary to establish a disease acceptance assessment tool for the adolescent generation so that it can be applied in the field.

Editor’s note: We acknowledge the grammatical inconsistencies in this abstract.

Parental Engagement in Consent Processes for Enrollment in Biomedical HIV Prevention Trials: Implications for Minor Adolescents’ Willingness to Participate
Original Article
Amelia Knopf, Claire Burke Draucker, J. Dennis Fortenberry, Mary A. Ott, Renata Arrington-Sanders, Daniel Reirden, John Schneider, Diane Straub, Susan Ofner, Giorgos Bakoyannis, Gregory Zimet
Journal of Adolescent Health, May 2023; 72(5) pp 703-711
Abstract
Purpose
Minor adolescents are often excluded from HIV prevention clinical trials due to unresolved ethical issues. Their under-representation in research leads to delayed access to new HIV prevention approaches. We examine the relationship between consent procedures, trial features, demographic and social characteristics, and minor adolescents’ willingness to participate (WTP) in biomedical HIV prevention research.
Methods
We recruited 14–17-year-olds at risk of HIV for this quasi-experimental study. Adolescents were randomly assigned to (1) self-consent, (2) adult permission required, or (3) parental permission required and underwent simulated consent procedures for two types of HIV prevention trials. They rated likelihood of participating in each study if offered the opportunity and completed a survey with demographic, social, and behavioral measures.
Results
One hundred and twenty nine adolescents with diverse identities and socioeconomic status enrolled. Among the 58% of participants who identified as lesbian, gay, bisexual, transgender, or queer (LGBTQ), 76% were out to at least one parent/guardian (outness). Mean WTP was 3.6 (of 5; 5 = definitely would participate) across all participants and both trial types. We found no evidence of an association between WTP and consent condition, LGBTQ identity, or outness. However, medical mistrust, communication with parents, and concern about HIV were associated with WTP.
Discussion
Our results suggest adolescents are willing to participate in HIV prevention trials and parental involvement in the consent process may not be the most important deciding factor. However, variation in WTP within consent groups, and variation in other significant variables, underscores the need for individualized approaches to recruitment and consent for these trials.

Editor’s note: This is a US based publication.

Children must co-design digital health research
Editorial
The Lancet Digital Health, 7 April 2023
Open Access
Excerpt
… A multipronged approach is needed to change prevalent risk behaviours in adolescents. Yet few eHealth studies have assessed whether multiple health behaviour change (MHBC) interventions work, even though risk behaviours commonly co-occur, with more than 80% of adolescents engaging in two or more risk behaviours and more than 33% engaging in three or more. In this issue, Katrina Champion and colleagues describe a cluster randomised trial in Australia of more than 6000 11–13-year-olds enrolled in a 6-week school-based MHBC web-based and app-based intervention (Health4Life) designed to modify six chronic disease risk behaviours. The trial showed that the intervention was not effective in modifying adolescent risk behaviours despite improving knowledge about chronic disease risk factors over 24 months. These results are consistent with a previous meta-analysis by the authors, showing that eHealth MHBC interventions were not effective in reducing alcohol use, smoking, or sugar-sweetened beverage intake among school students. But, why do so many of these digital interventions fail?…