Say what? Patients have poor immediate memory of major risks of interscalene block disclosed during the informed consent discussion
Original Article
Johnny Wei Bai, Faraj W W Abdallah, Melanie Cohn, Stephanie Ladowski, Poorna Madhusudan, Richard Brull
Regional Anesthesia & Pain Medicine, 23 August 2019
Abstract
Background 
Poor memory of disclosed risks can undermine informed consent and create medicolegal challenges. The extent to which patients remember the risks of peripheral nerve blockade following the informed consent discussion is unknown. This prospective cohort study evaluated patients’ immediate memory of risks related to interscalene block (ISB) that were disclosed during the preoperative informed consent discussion.
Methods 
Using a standardized script, patients scheduled for arthroscopic shoulder surgery were informed of the risks of ISB by an anesthesiologist in the preoperative assessment clinic. Immediately thereafter, consenting participants were asked to identify the risks of ISB from a printed list of nine true risks (four major and five minor) and nine ‘distractor’ items, which were unrelated adverse events and not disclosed. The primary outcome was the proportion of participants who remembered all four true major risks including long-term nerve damage, seizure, life-threatening event, and damage to the covering of the lung.
Results 
Among 125 participants, only 26 (21%) remembered all four major risks of ISB. The mean number of major risks remembered was 2±1 out of 4. Fifteen (12%) participants remembered all nine true risks. The mean number of true risks remembered was 6±2 out of 9. Multivariable analysis revealed that participants’ self-rated assessment of their memory was not associated with actual recall.
Conclusion 
Patients have poor immediate memory of the major risks related to ISB disclosed during the informed consent discussion. Under the present study conditions, the validity of the informed consent process for patients undergoing ISB may be undermined.

Obtaining consent for obstetric procedures
KatrinaHenderson, SiânGriffiths
Anaesthesia & Intensive Care Medicine, 19 August 2019
Abstract
Consent is a process that involves information disclosure of a proposed treatment or intervention. It includes a discussion of the risks relevant to that particular patient as well as the benefits and alternative options. The process must be clearly documented to provide a legal justification for treatment. Obtaining informed consent can be a challenge when a labouring woman is in severe pain or under the influence of strong analgesics. High-risk women should be encouraged to attend pre-assessment clinics to enable adequate time to process the information discussed. Pregnant women are presumed competent and are entitled to refuse treatment even if this risks their life or the life of their fetus. Rarely, if a woman is not considered competent to make decisions for herself, clinicians should take into account the underlying reasons and consider proceeding in their best interests under the doctrine of necessity or apply to the courts for approval of an intervention. This article summarizes current guidelines in relation to consent that have been updated to reflect recent case law.

Deferred consent for delivery room studies: the providers’ perspective
Original Article
Maria C den Boer, Mirjam Houtlosser, Elizabeth E Foglia, Enrico Lopriore, Martine Charlotte de Vries, Dirk P Engberts, Arjan B te Pas
Archives of Disease in Childhood: Fetal & Neonatal, 19 August 2019
Abstract
Objective 
To gain insight into neonatal care providers’ perceptions of deferred consent for delivery room (DR) studies in actual scenarios.
Methods 
We conducted semistructured interviews with 46 neonatal intensive care unit (NICU) staff members of the Leiden University Medical Center (the Netherlands) and the Hospital of the University of Pennsylvania (USA). At the time interviews were conducted, both NICUs conducted the same DR studies, but differed in their consent approaches. Interviews were audio-recorded, transcribed and analysed using the qualitative data analysis software Atlas.ti V.7.0.
Results                                                       
Although providers reported to regard the prospective consent approach as the most preferable consent approach, they acknowledged that a deferred consent approach is needed for high-quality DR management. However, providers reported concerns about parental autonomy, approaching parents for consent and ethical review of study protocols that include a deferred consent approach. Providers furthermore differed in perceived appropriateness of a deferred consent approach for the studies that were being conducted at their NICUs. Providers with first-hand experience with deferred consent reported positive experiences that they attributed to appropriate communication and timing of approaching parents for consent.
Conclusion 
Insight into providers’ perceptions of deferred consent for DR studies in actual scenarios suggests that a deferred consent approach is considered acceptable, but that actual usage of the approach for DR studies can be improved on.

Attitudes, Beliefs, and Practices of Aesthetic Plastic Surgeons Regarding Informed Consent
Accepted Manuscript
Chelsea O Hagopian, Teresa B Ades, Thomas M Hagopian, Erik M Wolfswinkel, W Grant Stevens
Aesthetic Surgery Journal, 30 July 2019
Abstract
Background
Best practice for informed consent in aesthetic plastic surgery is a process of shared decision-making (SDM), yet evidence strongly suggests this is not commonly reflected in practice nor is it supported by traditional informed consent documents (ICD). Falsely held beliefs by clinicians about SDM may contribute to its lack of adoption.
Objective
To understand the baseline attitudes, beliefs, and practices of informed consent among board-certified plastic surgeons with a primarily aesthetics practice.
Methods
A 15-question online survey was emailed to active members of the American Society for Aesthetic Plastic Society (ASAPS). Items included: demographics, Likert scales, free-text, acceptability, and one question seeking consensus on general information all patients must understand before any surgery.
Results
This survey appreciated a 13% response rate with a 52% completion rate across 10 countries and 31 U.S. states. 69% are very-extremely confident that ICD contain evidence-based information. 63% are not at all-not so confident in ICD effectiveness of prompting patients to teach-back essential information. 51% believe surgical ICD should be reviewed annually. 86% report assistance with patient education during informed consent. “ASAPS members” should be a source of evidence for content (free-text). 63% were somewhat-very satisfied with the survey and 84% will probably-definitely yes participate in future surveys.
Conclusions
Findings echo concerns in the literature that ICD are focused on disclosure not patient understanding. There is notable concern regarding information overload and retention, but less regarding the quality and completeness of information. Current culture suggests key clinician stakeholders are amenable to change.