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"Your child needs surgery": A survey-based evaluation of simulated expert consent conversations by key stakeholders
Zoe Atsaidis1, Stephan Robitaille2, Elena Guadagno3
1McGill University Faculty of Medicine & Health Sciences, Montreal, Quebec, Canada.
Insights
Expert pediatric surgeons
Area of Science:
- Pediatric Surgery
- Informed Consent
- Surgical Education
Background:
- Inadequate consent in pediatric surgery can lead to adverse outcomes.
- Exploring expert consenting practices is crucial for improving pre-operative care.
- Stakeholder perspectives are vital for understanding consent effectiveness.
Purpose of the Study:
- To explore expert consenting practices in pediatric surgery.
- To evaluate the effectiveness of consent conversations from multiple stakeholder viewpoints.
- To identify areas for improvement in the informed consent process.
Main Methods:
- Four pediatric surgeons conducted consent discussions for simulated low-risk and high-risk surgeries.
- Consent sessions were video-recorded and evaluated by diverse stakeholders (families, healthcare professionals).
- A semi-structured questionnaire assessed satisfaction and gathered qualitative feedback on the consent process.
Main Results:
- A high satisfaction rate (69-84%) was reported for the recorded consent conversations.
- Key themes for effective consent included surgeon empathy, communication, patient engagement, and sufficient information.
- Stakeholders suggested improvements such as visual aids and enhanced discussion of post-operative expectations.
Conclusions:
- The study highlights strengths and weaknesses in current pediatric surgical consent procedures.
- Multi-stakeholder input provides actionable insights for refining the informed consent process.
- Findings will inform the development of educational resources to improve consent practices.
Background:
Consent conversations in pediatric surgery are essential components of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, and others in the healthcare system. The aim of this study is to explore expert consenting practice from the key stakeholders' perspective.
Methods:
Four senior attending pediatric surgeons obtained consent from a standardized mother of a child requiring surgery in two scenarios: a low-risk elective surgery (inguinal hernia repair - Video 1), and a high-risk emergency surgery (intestinal atresia - Video 2). All sessions were recorded. Families of children who had undergone minor or major surgery, families without medical or surgical background, and healthcare professionals were invited to view and evaluate the videos using a semi-structured questionnaire.
Results:
Out of 251 distributed surveys, 56 complete responses were received. Thirty two participants (57.1%) evaluated video 1 and 24 (42.9%) evaluated. Overall, 22 (69%) respondents to video 1 and 20 (84%) respondents to video 2 were "very satisfied" with the recorded consent conversation. Qualitative responses shared common themes of valuing surgeon empathy, good surgeon communication, patient engagement, and adequate time and information. Suggestions for improvement included additional resources and visual aids, improved patient engagement, and discussion of post-operative expectations.
Conclusion:
Our data identifies strengths and gaps in the current consent process from the perspective of patient families and providers. Identified areas for improvement in the informed consent process based on multi-stakeholder input will guide the planned development of a consenting educational video resource.
Level Of Evidence:
IV.
