2017 HSC Section 2 - Practice Management

Original Research—Pediatric Otolaryngology

Informed Consent in Pediatric

Otolaryngology: What Risks and Benefits

Do Parents Recall?

Otolaryngology–

Head and Neck Surgery

2016, Vol. 155(2) 332–339

American Academy of

Otolaryngology—Head and Neck

Surgery Foundation 2016

Reprints and permission:

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DOI: 10.1177/0194599816641910

http://otojournal.org

Kiersten Pianosi

, Ayala Y. Gorodzinsky, PhD

Jill MacLaren Chorney, PhD

2,3

, Gerard Corsten, MD

Liane B. Johnson, MDCM

, and Paul Hong, MD

1,4

Sponsorships or competing interests that may be relevant to content are dis-

closed at the end of this article.

Abstract

Objective.

To evaluate parental recall of surgical risks and

benefits in pediatric otolaryngology and to assess for factors

that may influence recall.

Study Design.

Prospective cohort study.

Setting.

Academic pediatric otolaryngology clinic.

Subjects and Methods.

Eighty-four parents of children

years of age who underwent consultation for adeno/tonsillect-

omy and/or tympanostomy tube insertion were prospectively

enrolled. Consultation visits were video recorded and the

benefits and risks of surgery documented. Two weeks follow-

ing the consultation, parents were contacted for assessment

of recall of information discussed during the consultation.

Results.

Overall, parents recalled only one-third of the risks of

surgery mentioned by the surgeons. Parents were significantly

more likely to recall the benefits of surgery as opposed to the

risks (

.001). Nine parents (10.7%) reported that no bene-

fits were discussed during the consultation, and 10 (11.9%)

reported no mention of any risks. Inconsistencies were pres-

ent in which risks and benefits were mentioned by the provi-

ders. Parents who decided to proceed with surgery (58.3%)

were significantly less likely to recall the surgical risks than

those who did not (

.001). The specific surgeon involved,

the number of caregivers present, parental education level,

and prior surgical history did not influence recall.

Conclusion.

Parental recall of benefits and risks associated with

common pediatric otolaryngology procedures was poor. This

information is important because a low rate of recall may

influence parents’ perspectives of the procedure and could

alter their decision-making processes or expectations.

Methods to improve parental recall should be further studied.

Keywords

informed consent, complications, risks, adenotonsillectomy,

tympanostomy tube insertion

Received December 28, 2015; revised February 24, 2016; accepted

March 9, 2016.

n important aspect of the informed consent process

is to ensure that the benefits and risks of a surgical

procedure are well understood by the patients and

their family members. This is particularly important in

pediatric otolaryngology, as many operations in this subspe-

cialty are elective, and the benefits are not always clear or

guaranteed. Even the practice guidelines for a number of

pediatric otolaryngology conditions recognize the lack of

unequivocal data to support the option of some opera-

tions.

1,2

For example, a Cochrane review assessing the

effectiveness of tonsillectomy in chronic/recurrent acute

tonsillitis stated, ‘‘It is clear that some children get better

without any surgery. . . . The impact of surgery, as demon-

strated in the included studies, is modest.’’

In light of the unclear benefits in some circumstances,

the decision to proceed with surgery should be carefully

considered by parents. Moreover, although some of the pro-

cedures in pediatric otolaryngology could be considered

‘‘minor,’’ they are not without risks. Unfortunately, research

to date has shown that many patients have poor understand-

ing of their medical conditions and treatments

4-6

and that

recall of the information shared during consultation visits is

inadequate.

5-9

Even after undergoing a detailed informed

consent process, patients and family members have demon-

strated poor recall of the risks discussed during surgical

consultations.

9-13

Thus, a need exists to better understand

Division of Otolaryngology–Head and Neck Surgery, IWK Health Centre,

Halifax, Canada

Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada

Department of Anesthesia, Pain Management and Perioperative Medicine,

Dalhousie University, Halifax, Canada

School of Human Communication Disorders, Dalhousie University, Halifax,

Canada

Corresponding Author:

Paul Hong, MD, IWK Health Centre, 5850/5980 University Avenue, PO

Box 9700, Halifax, Nova Scotia B3K 6R8, Canada.

Email:

Paul.Hong@iwk.nshealth.ca

Reprinted by permission of Otolaryngol Head Neck Surg. 2016; 155(2):332-339.