405 Interventions to promote pre-op informed consent effective

April 01, 2014

PEARLS 405, September 2013, written by Brian R McAvoy

Clinical question
How effective are interventions to promote informed consent for patients undergoing surgical and other invasive healthcare treatments and procedures?

Bottom line
Most interventions to promote informed consent included the use of written or audiovisual aids. Interventions improved knowledge of the planned procedure immediately (for up to 24 hours), in the short term (for 1 to 14 days) and in the long term (for more than 14 days). Satisfaction with decision making was increased, decisional conflict was reduced, and consultation length slightly increased. There were no differences between the intervention and control for the outcomes of generalised anxiety, and either anxiety or satisfaction associated with the consent process.

Caveat
Limitations of the review include difficulties combining the results of studies due to variation in the procedures undergone by patients, the interventions used and outcomes measured. Only 1 study attempted to measure the primary outcome, which was informed consent as a unified concept, but this study was at high risk of bias. More commonly, studies measured secondary outcomes which were individual components of informed consent, such as knowledge, anxiety, and satisfaction with the consent process.

Context
Achieving informed consent is a core clinical procedure and is required before any surgical or invasive procedure is undertaken. However, it is a complex process which requires that patients are provided with information which they can understand and retain, that they are given the opportunity to consider their options, and that they are able to express their opinions and ask questions. There is evidence that at present some patients undergo procedures without informed consent being achieved.

Cochrane Systematic Review
Kinnersley P et al. Interventions to promote informed consent for patients undergoing surgical and other invasive health-care procedures. Cochrane Reviews, 2013, Issue 7. Art. No.: CD009445.DOI: 10.1002/14651858. CD009445. This review contains 65 studies involving 9021 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.