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“Your Child Needs Surgery”: A Survey-Based Evaluation of Simulated Expert Consent Conversations by Key Stakeholders

      Highlights

      • There is a need for better consent conversations in pediatric surgery informed by parents and healthcare providers.
      • Patients and families appreciate surgeon empathy, good surgeon communication, patient engagement, and adequate time for discussion and questions in a consent conversation.

      Summary

      Background

      Consent conversations in pediatric surgery are essential components of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, and others in the healthcare system. The aim of this study is to explore expert consenting practice from the key stakeholders’ perspective.

      Methods

      Four senior attending pediatric surgeons obtained consent from a standardized mother of a child requiring surgery in two scenarios: a low-risk elective surgery (inguinal hernia repair - Video 1), and a high-risk emergency surgery (intestinal atresia - Video 2). All sessions were recorded. Families of children who had undergone minor or major surgery, families without medical or surgical background, and healthcare professionals were invited to view and evaluate the videos using a semi-structured questionnaire.

      Results

      Out of 251 distributed surveys, 56 complete responses were received. Thirty two participants (57.1%) evaluated video 1 and 24 (42.9%) evaluated. Overall, 22 (69%) respondents to video 1 and 20 (84%) respondents to video 2 were “very satisfied” with the recorded consent conversation. Qualitative responses shared common themes of valuing surgeon empathy, good surgeon communication, patient engagement, and adequate time and information. Suggestions for improvement included additional resources and visual aids, improved patient engagement, and discussion of post-operative expectations.

      Conclusion

      Our data identifies strengths and gaps in the current consent process from the perspective of patient families and providers. Identified areas for improvement in the informed consent process based on multi-stakeholder input will guide the planned development of a consenting educational video resource.

      Level of Evidence

      IV.

      Keywords

      Abbreviations:

      REB (Research Ethics Board), MCH (The Montreal Children’s Hospital), SDM (Shared Decision Making), NICU (Neonatal Intensive Care Unit)
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