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the informed consent process in pediatric otolaryngology
and determine what factors may influence recall of the
information discussed during surgical consultations.
The primary objective of this study was to evaluate par-
ental recall of surgical risks and benefits associated with
common operations in pediatric otolaryngology. The sec-
ondary objective was to assess for factors that may influ-
ence recall. In particular, assessment was performed of
whether the context of the discussion (eg, other people in
the room), prior surgical history, parental education level, or
treatment choice (watchful waiting or surgery) would influ-
ence the rate of recall.
Materials and Methods
This study was part of a larger mixed-methods research
project assessing shared decision making in pediatric otolar-
yngology.
6
Local Institutional Review Board (IWK Health
Centre) approval was obtained.
Participants
Participants were recruited from a tertiary-level pediatric
hospital in eastern Canada. Consecutive parents were pro-
spectively enrolled if they had children
\
6 years of age
who were being evaluated for 1 of 4 conditions that may be
treated with surgery (
Table 1
). Exclusion criteria included
inability to speak English and/or the lack of decision-
making authority on behalf of the child. Clinic nurses
informed eligible parents of the study in the waiting room
before the consultation, and interested parents met with a
research assistant who described the study in detail and
obtained consent.
Procedure
If surgery was considered to be a treatment option, health
care providers discussed the risks and benefits of the surgi-
cal procedure during the consultation. After the discussion,
the surgeon obtained consent for surgery, which was then
followed by a short visit with the clinic nurse who covered
information pertaining to preoperative details (eg, where to
go for surgery, when to stop eating/drinking) and postopera-
tive care (eg, pain management/analgesic use). All visits
were video recorded with dual wall-mounted cameras in the
consultation room (one camera captured a full room view
and another captured the health care providers’ faces).
Two weeks following the consultation, participants com-
pleted a telephone interview with the research assistance
consisting of open- and closed-ended questions regarding
their recall of the information discussed during the visit.
Specifically, parents were encouraged to recall all risks and
benefits of the surgery discussed during the consultation.
Although parents were aware that this telephone call would
occur (‘‘cold calling’’ was not allowed according to the
Institutional Review Board), they were not made aware of
the purpose. Each interview was transcribed; transcriptions
of these conversations were later checked for accuracy.
Measures
Demographic questionnaire.
Relevant questions included rela-
tionship to child, parent and child age, parent marital status,
education level, ethnicity, household income, presence of
siblings, and previous surgical history of the patient and/or
sibling.
Risks and benefits coding.
Video recordings of the consultation
visits and transcripts of the follow-up phone calls were coded
for mention of the risks and benefits of surgery. Coding
sheets were created for each operation based on review
of the literature (see Appendix 1 at www.otojournal.org/ supplemental).Table 1.
Baseline Information of Participants.
n
%
Age of child, mo
12
8
9.5
13-24
28
33.3
25-36
20
23.8
37-48
16
19.0
49-60
12
14.3
Martial status
Married
59
70.2
Common law
12
14.3
Single
11
13.1
Divorced/separated
2
2.4
Ethnicity
Caucasian
75
89.3
African Canadian
4
4.8
Asian Canadian
2
2.4
First Nations/Native
1
1.2
Middle Eastern
1
1.2
Other
1
1.2
Education level
Completed high school or less
19
22.6
Community college
26
31.0
Undergraduate university
20
23.8
Graduate or postgraduate training
19
22.6
Conditions/surgery
a
Chronic/recurrent tonsillitis/
adenotonsillectomy
7
8.3
Obstructive sleep apnea/
adenotonsillectomy
31
36.9
Chronic/recurrent acute otitis media/ear
tubes
55
65.5
Chronic/recurrent nasal obstruction/
adenoidectomy
7
8.3
Surgical decision
Surgery
49
58.3
Watchful waiting
35
41.7
a
Sixteen children (19.0%) had
.
1 of these conditions.
Pianosi et al
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