Improving the Informed Consent Process

As part of the informed consent process before a surgery, an anesthesiologist comes and talks to the patient and parents about what will happen during the operation and about possible side effects or risks of anesthesia. This helps the patient and family develop realistic expectations for what will happen before, during and after the surgery. The anesthesiologist is also trying to establish a rapport with the patient and the patient’s family, which involves being sympathetic to their needs and fears, providing reassurance and setting a calm tone in a busy, sometimes noisy environment. Oftentimes the anesthesiologist finds himself or herself engaging the children in a game or story to distract them. There is an inherent tension in trying to do two distinct things at once, especially when the appropriate tone and type of information conveyed for these two goals (establishing rapport versus informing about the anesthetic plan) are quite different.

Anesthesiologist and bioethics fellow Dr. Kate Gentry recognizes that anesthesiologists are attempting to accomplish multiple goals when speaking to patients and parents prior to surgery, all in a limited window of time. She wonders if anesthesiologists are able to meet the standards for informed consent in this setting and if patient/parent satisfaction can be linked to the comprehensiveness of the informed consent process. She is exploring if there is a better way or time for the anesthesiologist to convey information about the plan and associated risks. She hope that this shift will enable the patient and family to better digest the information and give meaningful informed consent.

With Dr. Doug Opel, she is researching how to improve this process by studying the conversations that occur between anesthesiologists and patients and families and later interviewing parents about their satisfaction after the interaction.

This project might lead to pilot testing whether shifting the timing of the anesthesia informed consent process to earlier in the overall timeline could lead to a more complete informed consent. A shift in timing might help prevent the parents from getting overloaded with information immediately prior to their child’s surgery, when they might be reluctant to ask too many questions for fear of delaying the surgery or distracting the medical providers from preparing adequately for the surgery ahead.

“As the informed consent process is now, families get competing information or too much information at once. The time window is inadequate for true, ethical informed consent.”

Dr. Kate Gentry

Ultimate Goal

To understand more about patients’ and families’ experience with the informed consent process for anesthesia in order to be able to make improvements to how and when this information is delivered.