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A systematic review of medical risk disclosure techniques, and its application to ionising radiation risk
Introduction:
Ionising radiation is used extensively in medical imaging and has a demonstrated risk of causing cancer. However, the random nature of stochastic risks has resulted in ionising radiation risks being poorly disclosed to patients. This undermines the validity of a patient's provided informed consent, as without understanding stochastic risks, the consent is not informed. This systematic review seeks to provide a risk disclosure framework for practitioners by identifying an ideal protocol to disclose stochastic risks by considering the generalisability of advocated informed consent protocols from various medical fields.
Methods:
This systematic review searched three electronic databases for contemporary, peer-reviewed publications that defined and critiqued a clinically utilised informed consent protocol. Two independent researchers conducted multistage filtering, with a third researcher available to resolve conflicts. From the identified articles, clinically utilised risk disclosure tools were identified through a convergent, integrated data extraction process.
Results:
1401 unique articles were identified, of which, 20 available articles satisfied the inclusion criteria and passed a quality assessment tool modelled on Joanna Briggs Institute protocols. Risk disclosure protocols consist of two aspects: the media through which information is presented (e.g., verbal) and the method encompassing how this information is delivered (e.g., absolute statistics). This research considered the suitability of each advocated delivery media and method to disclose ionising radiation risk.
Conclusion:
The most advocated protocol to disclose ionising radiation risk involves a complementary approach, using written and verbal communication to deliver contextualised risk information with visual representations, ideally through pictographs.
Implications For Practice:
The consent model identified in this study stands to improve the quality, accuracy and accessibility of information being disclosed around stochastic risks to better inform patients across person-centred medical imaging contexts.
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