Informed Consent Prior to Surgery: It’s Not Just About Signing a Form

Featured in Boston Children’s Today
By: Adena Cohen-Bearak

As the sun rose on a cold November morning, 20 surgeons and 3 nurse practitioners from the Department of General Surgery at Boston Children’s Hospital gathered for the PERCS: Aligning Family-Team Expectations During Surgical Consent workshop developed by the Institute of Professionalism and Ethical Practice (IPEP). (PERCS is IPEP’s signature program, the Program to Enhance Relational & Communication Skills.)

Many surgeons and nurse practitioners are trained to understand the informed consent process as a legal exercise: there is a discussion with parents about the details of their child’s upcoming surgery, a presentation of the informed consent information to the family (risks, benefits, alternatives, etc.), and then responses to any questions. Then, right before the surgery itself, the family signs an informed consent document.

Done? Not so simple.

Research shows that patients only tend to absorb half of surgical informed consent information that they receive. This can result in the misalignment of expectations of the family compared with the expectations of the surgeon pertaining to the goals of the surgery and the process of post-op recovery, among others.

This risk of causing a family’s dissatisfaction about their child’s medical experience, even if the surgery was successful, is great, and can have a long-term impact on the family. In response to Boston Children’s Hospital’s focus on the Patient Care Experience, IPEP is doing something about this.

Through a combination of didactic learning, case simulations with trained actors posing as parents, experiential learning, use of everyday ethics and debriefing, surgeons and nurse practitioners learned to appreciate the importance of increasing their family focus during surgical consultations at November’s workshop.

When asked about the most valuable skills and information that they acquired, participants reported learning how to relay information to the family, communicating with children, and learning multiple ways to recognize family emotions and establish connections.

At the workshop, Craig Lillehei, MD, senior associate in Surgery and the project’s co-principal investigator, along with IPEP’s Director of Patient Safety and Quality Initiatives Sigall Bell, MD, took on the role of lead facilitators. The faculty and facilitators also included Adena Cohen-Bearak, MEd, MPH; Pam Varrin, PhD; Lisa Burgess and Lauren Mednick, PhD.

When asked about what they might do differently in the future based on their learning in the workshop, participants reported:

  • (Changing their) tone with families
  • Trying to make a personal connection with families
  • Recognizing/addressing parents’ and patients’ emotions
  • Asking the family for their baseline level of understanding

Family facilitator Lisa Burgess, a Boston Children’s parent and member of the Family Advocacy Council, commented: ”What an amazing day! This IS history in the making. Thank you all for all you are doing to make this work happen! It is a true privilege to be a part of this team.”

Aligning Family-Team Expectations During Surgical Consent has included the participation of surgeons and nurse practitioners in the departments of General Surgery, Neurosurgery, and Urology. IPEP is in the process of scheduling the last workshop with the Department of Neurosurgery to take place this spring 2017.

This work has been made possible through a generous grant by CRICO’s Patient Safety Risk Management Grants Program, and through funding from the Program for Patient Safety & Quality (PPSQ)

Posted in Aligning Expectations