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From the Archives
August 2010

Uninformed Consent for Children Undergoing Operations

Author Affiliations

Author Affiliation: Division of Gastrointestinal and Endocrine Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas.

Arch Surg. 2010;145(8):788-790. doi:10.1001/archsurg.2010.133

Archives of Otolaryngology—Head & Neck Surgery

Informed Consent in Pediatric Surgery: Do Parents Understand the Risks?

Daniel P. Nadeau, MD; Jeremy N. Rich, MD; Scott E. Brietzke, MD, MPH

Objective:   To investigate parental understanding of the risks of pediatric ear, nose, and throat surgery after receiving counseling with and without the use of informational aids.

Design:   Prospective, randomized trial.

Setting:   Academic tertiary care center.

Participants:   Parents of children undergoing ear, nose, and throat surgery.

Interventions:   Parents were randomized to receive standard informed consent with or without detailed informational aids.

Main Outcome Measures:   Parents completed identical questionnaires testing their general procedure knowledge and their recall of 9 specific surgical risks both immediately after counseling and on the day of surgery.

Results:   Thirty-four parents enrolled in and completed the study (18 in the control group and 16 in the test group). The mean time from informed consent to surgery was 6.3 days (range, 1-22 days). Parents in the test group scored significantly higher on identifying the 9 risks on both the preoperative questionnaire (mean score, 6.00 vs 4.44; P = .007, 2-tailed t test) and the postoperative questionnaire (6.25 vs 4.17; P < .001). There was a negative correlation (inverse relationship) between parent education score and risk recall, with parents with lower education levels scoring higher on both the preoperative (Pearson r = –0.36; P = .04) and the postoperative (r = –0.35; P = .04) surveys. The maternal parent recalled risks significantly better than the paternal parent, with surgical risk recall scores of 5.46 out of 9 vs 3.67 out of 9 (P = 2, 2-tailed t test).

Conclusions:   Parents of children undergoing ear, nose, and throat surgery recall far less than 100% of counseled risks. The use of detailed surgical risk counseling improves measured parental understanding of surgical risk. Parental educational level and maternal vs paternal parent may affect risk counseling recall.

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