Consent in gastrointestinal endoscopy: valid, informed and nurse-led
Christine Metcalf
Gastrointestinal Nursing, 19 Jun 2019; 17(5)
Abstract
Gastrointestinal endoscopy is generally safe, but these diagnostic and therapeutic interventions come with potential risks and thus require written, valid and informed consent, except in emergencies. Informed consent requires patients to receive and discuss information on the benefits, risks and nature of the procedure, as well as any alternatives. To consent, a patient must have the mental capacity to understand the information and use it to make and communicate a decision. Consent is a multi-stage procedure, beginning when endoscopy is first proposed and continuing into the intervention, as patients can withdraw consent during the procedure, whether sedated or not. For high-volume, low-risk procedures, the consent process can be safely delegated to qualified endoscopy nurses, with sufficient and relevant training, knowledge and support from the trust. Nurses competencies and other elements of the consent process should be regularly audited.

The Reading Level of Surgical Consent Forms in Hand Surgery
Original Research
Kevin Mertz, Matthew B. Burn, Sara L. Eppler, Robin N. Kamal
Journal of Hand Surgery Global Online, 19 June 2019
Abstract
Purpose
The average United States adult reads at an eighth-grade reading level. In an effort to ensure that patients understand written medical information, the National Institutes of Health and American Medical Association suggest that patient-directed material be written at a sixth- to eighth-grade reading level. We hypothesized that the mean reading level of surgical consent forms for hand surgery is not at or below an eighth-grade reading level (the suggested maximum from the National Institutes of Health).
Methods
We conducted a retrospective review of consecutive consent forms used for hand surgery patients from 7 hand surgeons at our institution from June, 2017 to October, 2017. Consent forms were reviewed to collect the hand-written portion describing the procedure. We also assessed our institution’s consent form template. This text was assessed for readability and reading level with the following tools: Flesch-Kincaid Grade Level and Flesch Reading Ease. We categorized the procedures written on each consent form by procedure type and then created simplified language for the same procedure below an eighth-grade reading level.
Results
Mean Flesch-Kincaid grade level of all consent forms was 10.5 (SD, 5.8) and mean Flesch readability was 33.6 (SD, 38.8), or difficult to read. A total of 78% and 58% of forms were written above the sixth- and eighth-grade reading levels, respectively. Readability was remarkedly poor; 94% and 88% of consent forms were written above sixth- and eighth-grade readability, respectively. The grade level of the consent form template was 17.1.
Conclusions
Most consent forms were written above a sixth- to eighth-grade reading level and may not have been well-understood by patients. It is possible for physicians to write on surgical consent forms at a reading level that patients are more likely to understand by opting for less specialty-specific words and writing in shorter sentences. Improving the readability of patient-directed materials is an approach to improving patient-centered care.

Informed Consent in Plastic Surgery, Evaluation of its Effectiveness for Mutual Satisfaction of Patient and Doctor: Comparison of Methods
Paolo G. Morselli, Andrea Lippi, Federico A. Giorgini, Erich Fabbri, Valentina Pinto
Journal of Plastic, Reconstructive & Aesthetic Surgery, 5 June 2019
Abstract
Background
The acquisition of signed informed consent is not always enough to ensure adequate medical protection. Particularly in plastic surgery improving the doctor-patient relationship by understanding the patient’s emotions and expectations becomes a determining factor when choosing the best therapeutic strategy for the subject in question, which may also include non-surgical eligibility.
Methods
90 patients, with various plastic surgery disabilities, were recruited and randomly divided into three groups: the 1st group underwent the “traditional” clinical interview, the 2nd to the clinical approach called Shared Decision Making (SDM), the third group received both the SDM and a questionnaire evaluating patient expectations (Expectation Questionnaire-Pgm). At the end of each interview, a specialist physician in Plastic, Reconstructive and Aesthetic Surgery was asked to fill in a questionnaire regarding his/her satisfaction with the method used. Likewise, the patient filled in a questionnaire on his/her satisfaction with the interview.
Results
For the doctors, the third method was superior in investigating patient expectations, emotions and personal preferences. For the patients, the third method score significantly higher than the first one for overall satisfaction, ability to evaluate personal preferences and needs; and higher than the first and second in assessing expectations.
Conclusions
For doctors, the SDM coupled with the Expectation Questionnaire-Pgm proved to be the most useful tool to understand patient expectations and emotions and thus improve the medical-patient relationship through shared decision-taking. The third method therefore makes for better patient coverage and improved informed consent, reducing the likelihood of litigation and better assessing non-fitness for operation.

Consent Obtained by Residents: Informed by the Uninformed?
Tait AR
The Journal of Clinical Ethics, 1 Jan 2019; 30(2) pp 163-166
Abstract
Informed consent is central to the bioethical principle of respect for persons, a process that involves a discussion between the physician and patient with disclosure of information sufficient to allow the patient to make an informed decision about her or his care. However, despite the importance of informed consent in clinical practice, the process is often ritualized, perfunctory, and performed by individuals with little or no training in the consent process. This article discusses the lack of medical students’ and residents’ training in informed consent and questions the practice of allowing untrained residents and surrogates to obtain consent from patients.