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Understanding the effectiveness of consent processes and conversations in pediatric surgery: A systematic-scoping review

      Highlights

      • There is a perceived lack of knowledge concerning the best practices of informed consent processes in pediatric surgery.
      • Effective consent conversations include multimedia use, individualized communication and multiple conversations.
      • Ineffective consent conversations are characterized by information overload, poor parental comprehension and anxiety.

      Abstract

      Background

      The consent conversation in pediatric surgery is an essential part of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, other healthcare workers and the healthcare system. We reviewed the published literature on what key stakeholders perceive are the components of effective and ineffective consenting processes in pediatric surgery.

      Methods

      A medical librarian searched seven databases to retrieve articles looking at the informed consenting process in surgical care for the pediatric population. Two independent reviewers screened all publications and categorized them by stakeholder perspectives (patient/family, surgical team, other healthcare team, and hospital administration or policy maker). General study characteristics, interventions to improve consent and features of effective and ineffective consent conversations were extracted.

      Results

      5079 titles and abstracts were screened, resulting in 88 full-text studies and 43 articles included in the final review. Most publications (51%) discussed informed consent only from the patient/family perspective, while 21% added surgeon's perspective. No study approached the consenting process from the perspective of all stakeholder groups. Effective consent components identified included use of multimedia, presence of multiple conversations prior to surgery, and individualized communication catered to unique family knowledge and needs. In contrast, ineffective conversations did not include a clear assessment of parental understanding, delivered too much information, and did not address parental anxiety.

      Conclusions

      The literature on the consenting process in pediatric surgery is narrow in stakeholder perspectives. Our findings highlight gaps in the literature and opportunities to improve the informed consent processes prior to pediatric surgery.

      Keywords

      Abbreviations:

      AHRQ (Agency for Healthcare Research and Quality), AMSTAR (A MeaSurement Tool to Assess systematic Reviews), CASP (Critical Appraisal Skills Programme), CMPA (Canadian Medical Protective Agency), ENT (Ear, Nose, Throat), JBI (Joanna Briggs Institute), MINORS (Methodological Index for Non Randomized Studies), NICE (National Institute for Health and Care Evidence), RCT (Randomized Control Trial), SANRA (Scale for the Assessment of Narrative Review Articles), SDM (Shared Decision Making)
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