How to effectively obtain informed consent in trauma patients: a systematic review

Abstract

BackgroundObtaining adequate informed consent from trauma patients is challenging and time-consuming. Healthcare providers must communicate complicated medical information to enable patients to make informed decisions. This study aimed to explore the challenges of obtaining valid consent and methods of improving the quality of the informed consent process for surgical procedures in trauma patients.MethodsWe conducted a systematic review of relevant English-language full-text original articles retrieved from PubMed (1961–August 2018) that had experimental or observational study design and involved adult trauma patients. Studies involving informed consent in clinical or research trials were excluded. Titles and abstracts of searched articles were reviewed and relevant data were extracted with a structured form. Results were synthesized with a narrative approach.ResultsA total of 2044 articles were identified in the initial search. Only eight studies were included in the review for narrative synthesis. Six studies involved orthopedic surgeries, one involved nasal bone surgeries, and one involved trauma-related limb debridement. Only one study was conducted in an emergency department. Information recall was poor for trauma patients. Risk recall and comprehension were greater when written or video information was provided than when information was provided only verbally. Patient satisfaction was also greater when both written and verbal information were provided than when verbal information alone was provided; patients who received video information were more satisfied than patients who received written or verbal information.ConclusionsMany articles have been published on the subject of informed consent, but very few of these have focused on trauma patients. More empirical evidence is needed to support the success of informed consent for trauma patients in the emergency department, especially within the necessarily very limited time frame. To improve the informed consent process for trauma patients, developing a structured and standardized informed consent process may be necessary and achievable; its effectiveness would require evaluation. Adequately educating and training healthcare providers to deliver structured, comprehensive information to trauma patients is crucial. Institutions should give top priority to ensuring patient-centered health care and improved quality of care for trauma patients.Electronic supplementary materialThe online version of this article (10.1186/s12910-019-0347-0) contains supplementary material, which is available to authorized users.

Barriers to Obtaining Informed Consent on Shortterm Surgical Missions

“… 5 , 6 However, STSMs are not without ethical issues; one of them is obtaining informed consent, 7 a process that nurtures 2 fundamental moral values: patient well-being and patient autonomy. 8 …”

A parental educational intervention to facilitate informed consent for pediatric procedural sedation in the emergency department: a parallel group randomized controlled trial

“…Patients who received video information were more satis ed than patients who received written or verbal information. [40] The present results show that the video-assisted informed consent intervention resulted in improved understanding compared with the conventional informed consent discussion.…”

“…Several strategies have been proposed to improve the consent process in the emergency setting. [40,15] One study reported that using information aids may improve parental satisfaction with surgical informed consent in children. [41] Another study revealed that visual aids may improve communication about surgery between pediatric surgeons and surrogates.…”

Does Written Informed Consent Comprehensively Inform Surgical Patients and is This Effective in Patient’s Decision-Making?

“…Due to this reason in the hospital practice of our region, most often patients are giving inadequate information about their surgery before operation. 1,5,6,7,8 Seeking informed consent is often a formal act in which a patient's signature is obtained, with physicians believing that an important obligation has been fulfilled regardless of whether the patient has been provided with adequate information about the medical intervention that is about to take place. 1 Although this general observation, there is limited research is available from our country about the usual practice of preoperative informed consent.…”