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Enhancing informed consent best practices: gaining patient, family and provider perspectives using reverse simulation
  1. Elizabeth Goldfarb1,
  2. John A Fromson1,2,
  3. Tristan Gorrindo1,2,
  4. Robert J Birnbaum1,2
  1. 1Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr John A Fromson Division of Postgraduate Medical Education, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Fl, Boston, MA 02114 jfromson{at}partners.org

Abstract

Background Obtaining informed consent in the clinical setting is an important yet challenging aspect of providing safe and collaborative care to patients. While the medical profession has defined best practices for obtaining informed consent, it is unclear whether these standards meet the expressed needs of patients, their families as well as healthcare providers. The authors sought to address this gap by comparing the responses of these three groups with a standardised informed consent paradigm.

Methods Piloting a web-based ‘reverse’ simulation paradigm, participants viewed a video showing a standardised doctor engaging in an informed consent discussion. The scenario depicted a simulated patient with psychotic symptoms who is prescribed an atypical antipsychotic medication. 107 participants accessed the simulation online and completed a web-based debriefing survey.

Results Survey responses from patients, family members and healthcare providers indicated disparities in information retention, perception of the doctor's performance and priorities for required elements of the consent process.

Conclusions To enhance existing informed consent best practices, steps should be taken to improve patient retention of critical information. Adverse events should be described in the short-term and long-term along with preventative measures, and alternative psychosocial and pharmacological treatment options should be reviewed. Information about treatment should include when the medication takes therapeutic effect and how to safely maintain the treatment. The reverse simulation design is a model that can discern gaps in clinical practice, which can be used to improve patient care.

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Footnotes

  • Competing interests None.

  • Ethics approval Approval provided by the Partners Healthcare Institutional Review Board.

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

  • Data sharing statement The MGH Division of Postgraduate Medical Education is in the process of creating a learning management system that may allow for future sharing of the data sets used for this article.

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