Diagnostic CT Scans: Institutional Informed Consent Guidelines and Practices at Academic Medical Centers

Lee, Christoph I.; Flaster, Harry V.; Haims, Andrew; Monico, Edward P.; Forman, Howard P.

doi:10.2214/ajr.05.0813

Cited by 57 publications

(32 citation statements)

References 32 publications

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“…6 Only 15% of patients at academic centers are told about radiation risk, compared to 85% being informed of contrast dye allergy. 9 Multiple studies over the past decade, including one of emergency physicians (EPs), 10 have reported physician lack of CT radiation dose knowledge, [10][11][12][13][14] but no efforts have been made to elucidate reasons for this lack of knowledge and other barriers to effective communication about radiation risk between physicians and patients in the ED.…”

mentioning

confidence: 99%

Barriers to Computed Tomography Radiation Risk Communication in the Emergency Department: A Qualitative Analysis of Patient and Physician Perspectives

Robey

Edwards

Murphy

2014

Academic Emergency Medicine

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Objectives: This qualitative study aimed to characterize the barriers to informed discussions between patients and emergency physicians (EPs) about radiation risk from computed tomography (CT) and to identify future interventions to improve patient understanding of CT radiation risk.Methods: This study used a focus group approach to collect concepts about radiation risk exposure from a national sample of EPs and a local sample of emergency department (ED) patients. A directed content analysis used an a priori medical ethics framework to explore themes from the focus groups while a subsequent normative ethics analysis compared these results with existing perceptions about discussing CT radiation risk.Results: Focus groups (three each for a total of 19 EPs and 27 patients) identified concepts consistent with core medical ethics principles: patients emphasized autonomy and nonmaleficence more than physicians, while physicians emphasized beneficence. Subjects' knowledge of radiation dose and risk were equivalent to previously published reports. When asked about whether they should talk about radiation with patients, 74% of EPs reported that radiation exposure should be discussed, but the study EPs self-reported doing so with only an average of 24% of patients. Patients reported wanting to hear about radiation from their physicians the next time they need CT scans and thought that a written handout would work better than any other method. When presented with options for how to discuss risk with patients, EPs reported needing easy access to risk information and preferred discussion over other communications approaches, but had mixed support of distributing patient handouts. Conclusions:The normative view that radiation from diagnostic CT should be discussed in the ED is shared by patients and physicians, but is challenged by the lack of a structured method to communicate CT radiation risk to ED patients. Our analysis identifies promising interest among physicians and patients to use information guides and electronic order prompts as potential informational tools to overcome this barrier.ACADEMIC EMERGENCY MEDICINE 2014; 21:122-129

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confidence: 99%

Barriers to Computed Tomography Radiation Risk Communication in the Emergency Department: A Qualitative Analysis of Patient and Physician Perspectives

Robey

Edwards

Murphy

2014

Academic Emergency Medicine

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“…However, radiation risk is discussed seldomly, and the technologist may also lack the requisite knowledge to carry out an informed conversation about these risks. 39 Differences in practice settings also create different challenges for direct radiologist-to-patient communication. If the radiology suite is remotely located, then a face-to-face talk with the patient may not be possible.…”

Section: Practice-related Challenges and Potential Solutionsmentioning

confidence: 99%

Communicating radiation risk to patients and referring physicians in the emergency department setting

Shyu¹,

Sodickson²

2016

BJR

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Heightened awareness about the radiation risks associated with CT imaging has increased patients' wishes to be informed of these risks, and has motivated efforts to reduce radiation dose and eliminate unnecessary imaging. However, many ordering providers, including emergency physicians, are ill prepared to have an informed discussion with patients about the cancer risks related to medical imaging. Radiologists, who generally have greater training in radiation biology and the risks of radiation, often do not have a face-to-face relationship with the patients who are being imaged. A collaborative approach between emergency physicians and radiologists is suggested to help explain these risks to patients who may have concerns about getting medical imaging.

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“…Many physicians don't discuss the risks of CT with their patients at all, as the practical challenge of communicating this topic deters them from entering into this detailed conversation (1). Although most academic medical centers currently have guidelines for informed consent regarding CT, only a minority of institutions inform patients about possible risks and alternatives to CT scans (10).…”

Section: Introductionmentioning

confidence: 99%

Impact of Education on Physician Attitudes toward Computed Tomography Utilization and Consent

Weigner¹,

Dewar²,

Basham³

et al. 2012

The Journal of Emergency Medicine

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Diagnostic CT Scans: Institutional Informed Consent Guidelines and Practices at Academic Medical Centers

Cited by 57 publications

References 32 publications

Barriers to Computed Tomography Radiation Risk Communication in the Emergency Department: A Qualitative Analysis of Patient and Physician Perspectives

Barriers to Computed Tomography Radiation Risk Communication in the Emergency Department: A Qualitative Analysis of Patient and Physician Perspectives

Communicating radiation risk to patients and referring physicians in the emergency department setting

Impact of Education on Physician Attitudes toward Computed Tomography Utilization and Consent

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