Primary caregivers’ experience with the informed consent process in the paediatric emergency department: An interview-based qualitative study

Wazir, Adonis; Sandokji, Ibrahim; Greaves, Morten; Sawaya, Rasha

doi:10.1093/pch/pxab007

Cited by 2 publications

(1 citation statement)

References 35 publications

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“…One hundred percent of parents report being very satisfied or satisfied with the consent process in our study, which is in line with a study of a smaller cohort looking at parental satisfaction with the consent process in the PED 27 and higher than reported in adult surgical literature. 28,29 Provider satisfaction increased and time to complete the consent form decreased after implementation of the precompleted consent form.…”

Section: Discussionsupporting

confidence: 92%

Impact of Using a Precompleted Consent Form for Procedural Sedation in the Pediatric Emergency Department

McCollum,

Silva,

Sigman

et al. 2023

Pediatr Emer Care

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Objectives This study aimed to compare elements discussed during the consent process for procedural sedation in the pediatric emergency department to documentation and parental recall before and after implementation of a standardized consent form. Methods This is a mixed-methods study combining retrospective electronic record review and cross-sectional surveys of providers and parents after consent for procedural sedation. Surveys were obtained before and after implementation of a precompleted consent form. Providers' survey responses were compared with consent documentation. Recall of consent elements discussed by linked parent-provider dyads were compared. Results Six hundred fifty-five encounters were reviewed. Pediatric emergency medicine fellows and pediatric emergency department-based pediatricians were more likely to document any benefit (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.0–2.4) or alternative (OR, 2.7; 95% CI, 1.8–3.9) compared with PEM attendings. Providers were more likely to report discussion of failure to complete the procedure (OR, 7.3; 95% CI, 2.3–23.3) and parents were more likely to recall discussion of this risk (OR, 5.3; 95% CI, 1.0–27.8) in the postintervention group. Based on provider recall, using the precompleted consent form was associated with providers discussing at least 2 of the 3 benefits (84.0% vs 97.2%, P < 0.01), 5 of the 5 risks (31% vs 67.7%, P < 0.01), and improved parental recall of risks (5.7% vs 22.9%, P = 0.03). More providers reported taking less than 1 minute to complete the form in the postimplementation group (12.0% vs 43.7%, P < 0.01). Conclusions Implementing a precompleted consent form for procedural sedation was associated with providers reporting decreased time spent completing the consent form and better alignment of key consent elements between reported provider discussion and parental recall.

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Section: Discussionsupporting

confidence: 92%

Impact of Using a Precompleted Consent Form for Procedural Sedation in the Pediatric Emergency Department

McCollum,

Silva,

Sigman

et al. 2023

Pediatr Emer Care

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Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study

Wilson,

Umana,

McCleary

et al. 2024

Arch Dis Child

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BackgroundFebrile infants under 3 months of age are at higher risk of invasive bacterial illness (IBI) when compared with older children. Increasingly sequential assessment based on age, clinical appearance and biomarkers is used to determine the risk of IBI, and appropriateness of invasive procedures such as lumbar puncture. The purpose of this qualitative study is to report parents and clinicians’ opinions on communication of risks and benefits of sequential assessment and tailored treatment.Methods18 parents enrolled in the Febrile Infant Diagnostic Assessment and Outcomes study and seven clinicians from England, Wales and Northern Ireland were purposively selected to participate in virtual qualitative interviews. Data were analysed thematically.ResultsTailored treatment plans were widely supported. Confidence in the clinician was central to parents’ attitude towards management recommendations. Parents’ decision-making preferences change throughout their child’s clinical journey, with an initial preference for clinician-led decisions evolving towards collaborative decision-making as their stress and anxiety reduce. There were widespread differences in preferences for how risk was discussed. Parents self-reported poor retention of information and felt communication adjuncts helped their understanding. Clinicians were generally positive about the use of clinical decision aids as a communication tool, rather than relying on them for decision-making.DiscussionParents want to feel informed, but their desire to be involved in shared decision-making evolves over time.Clinicians appear to use their clinical judgement to provide individualised information, evolving their communication in response to perceived parental needs.Poor information retention highlights the need for repetition of information and use of communication adjuncts.Trial registration numberNCT05259683.

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Primary caregivers’ experience with the informed consent process in the paediatric emergency department: An interview-based qualitative study

Cited by 2 publications

References 35 publications

Impact of Using a Precompleted Consent Form for Procedural Sedation in the Pediatric Emergency Department

Impact of Using a Precompleted Consent Form for Procedural Sedation in the Pediatric Emergency Department

Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study

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