Anesthesiology Residents' Eliciting of Patient Questions During Informed Consent with a Patient in Pain

Informed consent is a cornerstone of ethical practice. Eliciting patient questions during informed consent increases patient engagement and understanding, thus enhancing integrity of the consent process. However, a patient in visible pain can add an additional challenge to the informed consent process. The purpose of this research was to examine if and how anesthesiology residents ask for questions from a patient displaying severe pain during an informed consent simulation.

Anesthesiology residents recruited from three anesthesia residency programs were video recorded performing an informed consent with a 52-year-old White male simulated patient awaiting urgent repair of a perforated gastric ulcer who was displaying verbal and nonverbal signs of pain. Two independent coders evaluated whether, when and how residents elicited patient questions during the informed consent process.

Among a sample of 65 first- and third-year anesthesiology residents, more than 20% of residents did not elicit questions during the informed consent encounter. Those who elicited questions typically did so late in the process, with approximately 10% inviting questions only after the consent form had been signed. Most questions were closed-ended (yes/no questions). Although residents did not typically incorporate the patient's name when eliciting questions, most residents demonstrated eye contact. There were no differences in the number or characteristics of questions elicited based on resident gender or level of training.

Our findings suggest there is a need for increased education regarding the purpose and approach to eliciting patient questions during the informed consent process, especially for patients who are experiencing pain.