The use of bovine pericardial patches in vascular surgery: where do we draw the line in obtaining informed consent?
Stacie Hodge, Nicholas Greaves, David Murray
Annals of Vascular Surgery, 24 April 2021
Abstract
With advances in modern medicine there has been unprecedented growth in biological materials derived from either porcine or bovine products. Absolute or relative restrictions of the dietary consumption of bovine or porcine products among different religious groups are relatively well documented. However, there are no clear guidelines about the non-dietary use of animal products for patients with particular secular or religious beliefs. For a patient undergoing a carotid endarterectomy, induction with propofol, administration of heparin at the time of vessel clamping, use of a bovine pericardial patch for angioplasty, covering the wound with a hydrocolloid dressing and post-operative aspirin administration exposes the patient to animal products at every stage, from the moment they walk through the door. A number of articles have advocated obtaining informed consent when using animal products in healthcare but where should the line be drawn? In particular, should we consent for the use of bovine pericardium in vascular surgery? This paper reviews the evidence available and discusses our current standpoint from both a legal and ethical aspect.

Do we achieve the Montgomery standard for consent in orthopaedic surgery?
Xenia N Tonge, Henry Crouch-Smith, Vijay Bhalaik, William D Harrison
British Journal of Hospital Medicine, 21 April 2021
Abstract
Aims/Background
The Montgomery v Lanarkshire Health Board (2015) case set a precedent that has driven the modernisation of consenting practice. Failure to demonstrate informed consent is a common source of litigation. This quality improvement project aimed to provide pragmatic guidance for surgeons on consent and to improve the patient experience during decision making.
Methods
Elective orthopaedic patients were assessed and the quality of documented consent was recorded. Data were collected over two discrete cycles, with cycle 1 used as a baseline in practice. The following criteria were reviewed: grade of consenting clinician, alternative treatment options, description of specific risks, place and timing of consent and whether the patient received written information or a copied clinic letter. Cycle 1 results were presented to clinicians; a teaching session was provided for clinicians on the standard of consent expected and implementation of a change in practice was established with a re-audit in cycle 2.
Results
There were 111 patients included in cycle 1, and 96 patients in cycle 2. Consent was undertaken mostly by consultants (54%). Specific patient risks were documented in 50% of patients in cycle 1 and 60% in cycle 2. Risks associated with a specific procedure were documented in 42% in cycle 1 and 76% in cycle 2, alternative options in 48% (cycle 1) and 66% (cycle 2). A total of 14% of patients in cycle 1 and 8% in cycle 2 had documented written information provision. Copied letters to patients was only seen in 12% of all cycles. Documentation from dedicated consenting clinics outperformed standard clinics.
Conclusions
Highlighting poor documentation habits and refining departmental education can lead to improvements in practice. The use of consenting clinics should be considered and clinicians should individually reflect on how to address their own shortcomings. Other units should strongly consider a similar audit. This article provides stepwise advice to improve consent and specifics from which to audit.

Informed consent in interventional radiology – are we doing enough?
Akash Prashar, Saqib Butt, Davide Giuseppe Castiglione, Nadeem Shaida
British Journal of Radiology, 21 April 2021
Abstract
Objectives
Obtaining informed consent is a mandatory part of modern clinical practice. The aim of this study was to identify how often complications relating to Interventional Radiology (IR) procedures were discussed with the patient prior to the procedure.
Methods
A retrospective analysis of 100 patients who experienced a complication related to an IR procedure was performed. The patient’s procedure consent form was examined to identify whether the complication they experienced had been discussed as a possible risk. Other parts of the consent form relating to need for blood transfusion and the need for further procedures were also examined.
Results
39% of patients who experienced a complication did not have the complication documented as a potential risk on the consent form. 14% of patients required a blood transfusion but were not consented for this. 42% of patients required a further procedure or operation but were not warned of this.
Conclusion
The model of gaining informed consent on the day of procedure is no longer valid. Better education and the use of clinics, patient information sheets and other resources is essential.

Pre-Abortion Informed Consent Through Telemedicine vs. in Person: Differences in Patient  Demographics and Visit Satisfaction
Original Article
Shelly Kaller, Sara Daniel, Sarah Raifman, M. Antonia Biggs, Daniel Grossman
Women’s Health Issues, 5 April 2021
Abstract
Purpose
Utah law requires patients to have a face-to-face “informed consent” visit at least 72 hours prior to abortion. Planned Parenthood Association of Utah (PPAU) offers this visit via telemedicine as an alternative to an in-person visit, which can require burdensome travel. This novel study identifies factors associated with using telemedicine for informed consent, patients’ reasons for using it, and experiences with it, compared to in-person informed consent.
Methods
In 2017 and 2018, patients 18 years and older seeking abortion at PPAU completed a self-administered online survey about their experiences with the informed consent visit. We used linear and logistic regression models to compare participants’ demographic characteristics by informed consent visit type, and descriptive statistics to describe reasons for using each visit type and experiences with the visit. Multivariable logistic regression models examined associations between visit type and satisfaction.
Results
Responses from 166 telemedicine patients and 217 in-person informed consent patients indicate that telemedicine participants would have had to travel significantly further than in-person participants traveled to attend the visit at the clinic (mean of 65 miles versus 21 miles, p < .001). In multivariable analyses, telemedicine participants had higher odds of being “very satisfied” with the visit (aOR, 2,89; 95% CI: 1.93–4.32) and “very comfortable” asking questions during the visit (aOR, 3.76; 95% CI: 2.58–5.49), compared to participants who attended in-person visits.
Conclusions
Telemedicine offers a convenient, acceptable option for mandated pre-abortion informed consent visits and reduces the burden of additional travel and associated barriers for some patients, particularly those who live further away from clinics.

[In search of open minds and shared consent – Information, treatment options and postoperative care from the patient’s perspective]
Ganz-Blättler U
Therapeutische Umschau. Revue Therapeutique, 1 April 2021; 78(3) pp 149-157
Abstract
This paper addresses knowledge gaps which are prone to handicap the ongoing communication process between medical / care personnel and patients of breast cancer, due to everyday routine and presumed lack of time. The respective qualitative studies do point to divergent expectations with regards to medical consultations and indicate that patients’ satisfaction with therapeutic measures, which were decided in advance, might be improved. Three exemplary aspects of doctor-patient communication are then looked at closer: first the variety of treatment options offered, second the risk of expressing unconscious bias regarding patients’ physical appearance and identity, and third the increasingly acknowledged desire of breast cancer patients to consult (… additionally, not alternatively) with other patients that are, or were previously affected by breast cancer and confronted with the decisions this condition entails.

Editor’s note: This is a German language publication.

Informed consent: What risks are material to patients consenting for urological procedures?
Research Article
Nadine McCauley, Siya Lodhia, Andrea Ong, Calum Clark, Tim Lane
Journal of Clinical Urology, 31 March 2021
Abstract
Objective
This study aimed to assess patient recall of the consent discussion for urological procedures and to identify which risks were material to urology patients.
Methods
A total of 102 patients undergoing urological procedures were interviewed in the 24-hour period surrounding the procedure. A self-designed, piloted questionnaire recorded information from the patient’s signed consent form and patient-reported data of the consent discussion.
Results
The mean patient recall was 2.06 risks, whereas the average number of risks listed by the operating surgeon on the consent form was 5.69 risks. The most frequently recalled risk was impotence (91%), followed by urinary incontinence (63%) and haematuria (61%). The risks associated with poorest patient recall were stent symptoms (0%), urethral catheter insertion (5%) and recurrence (8%).
Conclusions
Poor patient recall of the consent discussion has again been demonstrated in this study. However, certain urological procedure risks are better recalled by patients, with impotence, urinary incontinence and haematuria being most frequently recalled. Medical terminology such as stent or catheter may be poorly recalled due to a disparity in understanding between patient and clinician. Clinicians should be aware of poor patient recall when consenting for urology procedures and should ensure precise documentation.

Harming one to benefit another: The paradox of autonomy and consent in maternity care
Original Article
Elselijn Kingma
Bioethics, 11 December 2020
Open Access
Abstract
This paper critically analyses ‘the paradox of autonomy and consent in maternity care’. It argues that maternity care has certain features that increase the need for explicit attention to, and respect for, both autonomy and rigorous informed consent processes. And, moreover, that the resulting need is considerably greater than in almost all other areas of medicine. These features are as follows: (1) maternity care involves particularly socially sensitive body parts that are regularly implicated in consent-centred procedures, as well as in unconsented interventions, in ordinary, non-medical life; and (2) much of maternity care (especially intervening in childbirth) is medically unique, in that it harms one patient (the mother) not primarily for the promotion of her own health but for the benefit of another (the baby). The apt comparison, within medicine, is therefore with non therapeutic research and transplantation medicine—both of which have elevated consent requirements characterized by very rigorous consent processes. At the same time—and this delivers the titular paradox—the importance of autonomy and consent in maternity care is at particular risk of being denied or disregarded. Jointly, these considerations make a very strong case for change: attention to and respect for autonomy and consent should be (1) core values; (2) key points of practical attention in the years ahead; and (3) central quality indicators in maternity care.