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Understanding the effectiveness of consent processes and conversations in pediatric surgery: A systematic-scoping
Zoe Atsaidis1, Ryan Antel1, Elena Guadagno2
1Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, Quebec H3G 2M1, Canada.
Insights
Improving pediatric surgical consent requires understanding all stakeholder needs. Effective consent involves clear communication and addressing parental anxiety, while current literature often lacks a comprehensive, multi-perspective view.
Area of Science:
- Pediatric Surgery
- Informed Consent
- Healthcare Communication
Background:
- Informed consent is crucial in pediatric surgery, yet inadequate processes have serious consequences.
- Literature review focused on stakeholder perceptions of effective and ineffective pediatric surgical consent.
Purpose of the Study:
- To review published literature on key stakeholder perceptions of pediatric surgical consent.
- Identify components of effective and ineffective consent conversations.
Main Methods:
- Systematic literature search across seven databases.
- Screening and categorization of 43 articles by stakeholder perspective (patient/family, surgical team, etc.).
Main Results:
- Most studies (51%) focused solely on patient/family perspectives; none included all stakeholders.
- Effective consent: multimedia use, multiple conversations, individualized communication.
- Ineffective consent: lack of understanding assessment, information overload, unaddressed parental anxiety.
Conclusions:
- The current literature on pediatric surgical consent lacks diverse stakeholder perspectives.
- Identified gaps offer opportunities to enhance pre-operative informed consent processes.
Background:
The consent conversation in pediatric surgery is an essential part of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, other healthcare workers and the healthcare system. We reviewed the published literature on what key stakeholders perceive are the components of effective and ineffective consenting processes in pediatric surgery.
Methods:
A medical librarian searched seven databases to retrieve articles looking at the informed consenting process in surgical care for the pediatric population. Two independent reviewers screened all publications and categorized them by stakeholder perspectives (patient/family, surgical team, other healthcare team, and hospital administration or policy maker). General study characteristics, interventions to improve consent and features of effective and ineffective consent conversations were extracted.
Results:
5079 titles and abstracts were screened, resulting in 88 full-text studies and 43 articles included in the final review. Most publications (51%) discussed informed consent only from the patient/family perspective, while 21% added surgeon's perspective. No study approached the consenting process from the perspective of all stakeholder groups. Effective consent components identified included use of multimedia, presence of multiple conversations prior to surgery, and individualized communication catered to unique family knowledge and needs. In contrast, ineffective conversations did not include a clear assessment of parental understanding, delivered too much information, and did not address parental anxiety.
Conclusions:
The literature on the consenting process in pediatric surgery is narrow in stakeholder perspectives. Our findings highlight gaps in the literature and opportunities to improve the informed consent processes prior to pediatric surgery.
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