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A novel method to enhance informed consent: a prospective and randomised trial of form-based versus electronic assisted informed consent in paediatric endoscopy
  1. Joel A Friedlander1,3,
  2. Greg S Loeben2,
  3. Patricia K Finnegan1,
  4. Anita E Puma1,
  5. Xuemei Zhang4,
  6. Edwin F de Zoeten1,
  7. David A Piccoli1,
  8. Petar Mamula1
  1. 1Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
  2. 2Bioethics Program, Department of Biomedical Science, College of Health Sciences, Midwestern University, Glendale, Arizona, USA
  3. 3Division of Gastroenterology, Department of Pediatrics, Doernbecher Children's Hospital, Center for Ethics in Health Care, Oregon Health and Science University, Portland, Oregon, USA
  4. 4Division of Biostatistics and Data Management, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Joel A Friedlander, Division of Gastroenterology, Department of Pediatrics, Doernbecher Children's Hospital, Center for Ethics in Health Care, Oregon Health and Science University (OHSU), 707 SW Gaines Street, Mailcode CDRCP, 707 SW Gaines Street, Portland, OR 97239, USA; friedlan{at}ohsu.edu

Objectives To evaluate the adequacy of paediatric informed consent and its augmentation by a supplemental computer-based module in paediatric endoscopy.

Methods The Consent-20 instrument was developed and piloted on 47 subjects. Subsequently, parents of 101 children undergoing first-time, diagnostic upper endoscopy performed under moderate IV sedation were prospectively and consecutively, blinded, randomised and enrolled into two groups that received either standard form-based informed consent or standard form-based informed consent plus a commercial (Emmi Solutions, Inc, Chicago, Il), sixth grade level, interactive learning module (electronic assisted consent). Anonymously and electronically, the subjects' anxiety (State Trait Anxiety Inventory), satisfaction (Modified Group Health Association of America), number of questions asked, and attainment of informed consent were assessed (Consent-20). Statistics were calculated using t test, paired t test, and Mann Whitney tests.

Results The ability to achieve informed consent, as measured by the new instrument, was 10% in the control form-based consent group and 33% in the electronic assisted consent group (p<0.0001). Electronically assisting form-based informed consent did not alter secondary outcome measures of subject satisfaction, anxiety or number of questions asked in a paediatric endoscopy unit.

Conclusions This study demonstrates the limitations of form-based informed consent methods for paediatric endoscopy. It also shows that even when necessary information was repeated electronically in a comprehensive and standardised video, informed consent as measured by our instrument was incompletely achieved. The supplemental information did, however, significantly improve understanding in a manner that did not negatively impact workflow, subject anxiety or subject satisfaction. Additional study of informed consent is required.

Clinical trial registration number ClinicalTrials.gov Identifier NCT00899392.

  • Informed consent
  • pediatrics
  • paediatric endoscopy
  • bioethics
  • procedural consent
  • upper endoscopy
  • EGD
  • anxiety
  • satisfaction
  • computers
  • electronics
  • computer based learning
  • technology/risk assessment
  • education for healthcare professionals
  • informed consent
  • minors/parental consent
  • third party consent/incompetents

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Objectives To evaluate the adequacy of paediatric informed consent and its augmentation by a supplemental computer-based module in paediatric endoscopy.

Methods The Consent-20 instrument was developed and piloted on 47 subjects. Subsequently, parents of 101 children undergoing first-time, diagnostic upper endoscopy performed under moderate IV sedation were prospectively and consecutively, blinded, randomised and enrolled into two groups that received either standard form-based informed consent or standard form-based informed consent plus a commercial (Emmi Solutions, Inc, Chicago, Il), sixth grade level, interactive learning module (electronic assisted consent). Anonymously and electronically, the subjects' anxiety (State Trait Anxiety Inventory), satisfaction (Modified Group Health Association of America), number of questions asked, and attainment of informed consent were assessed (Consent-20). Statistics were calculated using t test, paired t test, and Mann Whitney tests.

Results The ability to achieve informed consent, as measured by the new instrument, was 10% in the control form-based consent group and 33% in the electronic assisted consent group (p<0.0001). Electronically assisting form-based informed consent did not alter secondary outcome measures of subject satisfaction, anxiety or number of questions asked in a paediatric endoscopy unit.

Conclusions This study demonstrates the limitations of form-based informed consent methods for paediatric endoscopy. It also shows that even when necessary information was repeated electronically in a comprehensive and standardised video, informed consent as measured by our instrument was incompletely achieved. The supplemental information did, however, significantly improve understanding in a manner that did not negatively impact workflow, subject anxiety or subject satisfaction. Additional study of informed consent is required.

Clinical trial registration number ClinicalTrials.gov Identifier NCT00899392.

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Footnotes

  • Funding This study was funded by the Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4318, USA.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the The Children's Hospital of Philadelphia Institutional Review Board #2008-6-6053.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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