Informed Consent and Risk Presentations by Radiology Trainees for Core Liver Biopsies: Shortcomings and Opportunities...

Informed consent is both a legal and ethical requirement and an interpersonal communication. The quality and completeness of consent discussions may influence patients' perceptions of risk, anxiety, confidence, and procedural experience. The goal of this study was to evaluate how trainees conduct informed consent to patients undergoing core liver biopsies.

Fifty consent conversations were recorded, transcribed verbatim, and analyzed. The conversations were assessed for content, completeness, and presentation. Three levels of completeness (basic, intermediate, and advanced) were based on published standards. Inductive and deductive qualitative content analysis was used to find patterns in the coded data. Patients' anxiety, confidence, and pain perception were measured before the consent and after the procedure. The age, sex, post-graduate year, and race of the trainees were recorded to assess the effects of these factors.

Twenty-seven of fifty consent conversations (54%) met the predefined criteria for basic consent completeness. Eight conversations (16%) met criteria for intermediate completeness, and one conversation (2%) met criteria for advanced completeness. The patients reported no change in their anxiety, pain, or confidence from before the consent to after the procedure. No effect could be attributed to trainees' characteristics. Consent conversations were insufficiently detailed for the evaluation of risk framing strategies or for conversation analysis.

The informed consent conversation, as conducted by radiology trainees, is often incomplete and insubstantial. Trainees need guidance on the essential content of informed consent, how to frame risk, and how to engage patients in a two-way discussion.