Informed Consent Challenges: A Mixed-Methods Study of Hospital Ethics Consultations

Area of Science:

• Medical Ethics
• Clinical Decision-Making
• Healthcare Policy

Background:

• Hospital ethics committees are crucial for navigating complex patient consent issues.
• Existing research indicates deficiencies in consent forms and information delivery.
• There is limited understanding of real-world ethics consultations specifically addressing consent.

Purpose of the Study:

• To examine common challenges encountered in healthcare consent discussions.
• To compare patient and consultation characteristics of consent-related versus non-consent-related ethics consults.

Main Methods:

• Analysis of de-identified ethics consult notes and patient data from a quaternary care academic medical center (2014-2024).
• Classification of consults into consent-related and non-consent-related categories.
• Statistical comparison using chi-square, Fisher's exact, and Wilcoxon rank-sum tests, with logistic regression for theme associations.

Main Results:

• Out of 4,127 consults, 137 (3.3%) were consent-related.
• Consent consults more frequently involved adult (96.4%) and female (58.4%) patients and were less complex (36.5%) compared to non-consent consults.
• Key issues in consent consults included capacity (65.0%), surrogate decision-making (46.0%), and communication barriers (38.0%).

Conclusions:

• Consent-related ethics consults exhibit distinct patient demographics and complexity profiles.
• Capacity, surrogate decision-making, and communication challenges are primary concerns in consent discussions.
• Findings offer actionable strategies to enhance consent protocols, patient-clinician communication, and ethical decision-making in healthcare settings.