Gentry Katherine R, Lepere Katherine, Opel Douglas J
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
Paediatr Anaesth. 2017 Dec;27(12):1253-1260. doi: 10.1111/pan.13270. Epub 2017 Oct 26.
Informed consent for pediatric anesthesia is unique because it is (1) obtained from surrogates (ie, parents) rather than from the patient and (2) sought after parents have authorized the surgical intervention. There are limited data on how pediatric anesthesia informed and consent discussions are conducted. The purpose of this study was to characterize the content of preanesthesia informed consent discussions and assess their impact on parent recall and understanding.
We conducted a cross-sectional observational study at a tertiary pediatric hospital. We audio-recorded and transcribed preanesthesia consent discussions between pediatric anesthesia providers and parents of children undergoing elective surgery. Parents were recruited on the day of surgery and completed a survey postdiscussion to assess their recall and perceived understanding. We used directed content analysis to identify 7 informed consent elements: (i) description of the plan; mention of (ii) alternatives, (iii) risks, and (iv) benefits; (v) discussion of uncertainties; (vi) assessment of comprehension; and (vii) solicitation of a decision. We used multivariable logistic regression to explore the association between discussions that included 3 informed consent elements (description of plan, mention of risks, and mention of benefits) and parent recall and understanding of these elements.
We analyzed 97 discussions involving 41 different anesthesia providers. The element most frequently included in preanesthesia discussions was a description of the plan (100%); the least frequently included was decision solicitation (18%). Seventy-one percent of discussions included ≥5 informed consent elements and 70% included a description of the plan, mention of risks, and mention of benefits. Parental recall of these 3 informed consent elements was associated with their inclusion in the preanesthesia discussion (75% vs 34%), and more parents understood all 3 elements if they had reported (vs not reported) recall of all 3 elements (97% vs 53%).
Most pediatric preanesthesia discussions include ≥5 informed consent elements and describe the plan, mention risks, and mention benefits. Inclusion of these latter 3 consent elements was associated with parental recall of these elements but not understanding.
小儿麻醉的知情同意具有独特性，因为它是（1）从替代者（即父母）而非患者处获得，且（2）是在父母授权手术干预后进行的。关于小儿麻醉知情同意讨论如何开展的数据有限。本研究的目的是描述麻醉前知情同意讨论的内容，并评估其对父母记忆和理解的影响。
我们在一家三级儿童医院进行了一项横断面观察性研究。我们对小儿麻醉提供者与接受择期手术患儿的父母之间的麻醉前同意讨论进行了录音和转录。父母在手术当天被招募，并在讨论后完成一项调查，以评估他们的记忆和感知理解。我们使用定向内容分析法确定了7个知情同意要素：（i）计划描述；提及（ii）替代方案、（iii）风险和（iv）益处；（v）不确定性讨论；（vi）理解评估；以及（vii）征求决定。我们使用多变量逻辑回归来探讨包含3个知情同意要素（计划描述、风险提及和益处提及）的讨论与父母对这些要素的记忆和理解之间的关联。
我们分析了涉及41名不同麻醉提供者的97次讨论。麻醉前讨论中最常包含的要素是计划描述（100%）；最不常包含的是征求决定（18%）。71%的讨论包含≥5个知情同意要素，70%的讨论包含计划描述、风险提及和益处提及。父母对这3个知情同意要素的记忆与它们在麻醉前讨论中的包含情况相关（75%对34%），并且如果父母报告（与未报告相比）回忆起所有3个要素，更多父母理解所有3个要素（97%对53%）。
大多数小儿麻醉前讨论包含≥5个知情同意要素，并描述计划、提及风险和提及益处。包含后3个同意要素与父母对这些要素的记忆相关，但与理解无关。
