2017 HSC Section 2 - Practice Management

Reprinted by permission of Otolaryngol Head Neck Surg. 2016; 155(2):332-339.

Original Research—Pediatric Otolaryngology

Otolaryngology– Head and Neck Surgery 2016, Vol. 155(2) 332–339 American Academy of Otolaryngology—Head and Neck

Informed Consent in Pediatric Otolaryngology: What Risks and Benefits Do Parents Recall?

Surgery Foundation 2016 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599816641910 http://otojournal.org

Kiersten Pianosi 1 , Ayala Y. Gorodzinsky, PhD 2 , Jill MacLaren Chorney, PhD 2,3 , Gerard Corsten, MD 1 , Liane B. Johnson, MDCM 1 , and Paul Hong, MD 1,4

Received December 28, 2015; revised February 24, 2016; accepted March 9, 2016. A n important aspect of the informed consent process is to ensure that the benefits and risks of a surgical procedure are well understood by the patients and their family members. This is particularly important in pediatric otolaryngology, as many operations in this subspe- cialty are elective, and the benefits are not always clear or guaranteed. Even the practice guidelines for a number of pediatric otolaryngology conditions recognize the lack of unequivocal data to support the option of some opera- tions. 1,2 For example, a Cochrane review assessing the effectiveness of tonsillectomy in chronic/recurrent acute tonsillitis stated, ‘‘It is clear that some children get better without any surgery. . . . The impact of surgery, as demon- strated in the included studies, is modest.’’ 3 In light of the unclear benefits in some circumstances, the decision to proceed with surgery should be carefully considered by parents. Moreover, although some of the pro- cedures in pediatric otolaryngology could be considered ‘‘minor,’’ they are not without risks. Unfortunately, research to date has shown that many patients have poor understand- ing of their medical conditions and treatments 4-6 and that recall of the information shared during consultation visits is inadequate. 5-9 Even after undergoing a detailed informed consent process, patients and family members have demon- strated poor recall of the risks discussed during surgical consultations. 9-13 Thus, a need exists to better understand 1 Division of Otolaryngology–Head and Neck Surgery, IWK Health Centre, Halifax, Canada 2 Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada 3 Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada 4 School of Human Communication Disorders, Dalhousie University, Halifax, Canada Corresponding Author: Paul Hong, MD, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, Nova Scotia B3K 6R8, Canada. Email: Paul.Hong@iwk.nshealth.ca

Sponsorships or competing interests that may be relevant to content are dis- closed at the end of this article.

Abstract Objective. To evaluate parental recall of surgical risks and benefits in pediatric otolaryngology and to assess for factors that may influence recall.

Study Design. Prospective cohort study.

Setting. Academic pediatric otolaryngology clinic. Subjects and Methods. Eighty-four parents of children \ 6 years of age who underwent consultation for adeno/tonsillect- omy and/or tympanostomy tube insertion were prospectively enrolled. Consultation visits were video recorded and the benefits and risks of surgery documented. Two weeks follow- ing the consultation, parents were contacted for assessment of recall of information discussed during the consultation. Results. Overall, parents recalled only one-third of the risks of surgery mentioned by the surgeons. Parents were significantly more likely to recall the benefits of surgery as opposed to the risks ( P \ .001). Nine parents (10.7%) reported that no bene- fits were discussed during the consultation, and 10 (11.9%) reported no mention of any risks. Inconsistencies were pres- ent in which risks and benefits were mentioned by the provi- ders. Parents who decided to proceed with surgery (58.3%) were significantly less likely to recall the surgical risks than those who did not ( P \ .001). The specific surgeon involved, the number of caregivers present, parental education level, and prior surgical history did not influence recall. Conclusion. Parental recall of benefits and risks associated with common pediatric otolaryngology procedures was poor. This information is important because a low rate of recall may influence parents’ perspectives of the procedure and could alter their decision-making processes or expectations. Methods to improve parental recall should be further studied.

Keywords informed consent, complications, risks, adenotonsillectomy, tympanostomy tube insertion

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