scholarly journals Informed Consent for Intraoperative Neural Monitoring in Thyroid and Parathyroid Surgery – Consensus Statement of the International Neural Monitoring Study Group

2021 ◽  
Vol 12 ◽  
Author(s):  
Che-Wei Wu ◽  
Tzu-Yen Huang ◽  
Gregory W. Randolph ◽  
Marcin Barczyński ◽  
Rick Schneider ◽  
...  
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Consensus Statement ◽  
Consent Process ◽  
Study Group ◽  
Shared Decision ◽  
Parathyroid Surgery ◽  
Monitoring Study ◽  
Neural Monitoring

In the past decade, the use of intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery has been widely accepted by surgeons as a useful technology for improving laryngeal nerve identification and voice outcomes, facilitating neurophysiological research, educating and training surgeons, and reducing surgical complications and malpractice litigation. Informing patients about IONM is not only good practice and helpful in promoting the efficient use of IONM resources but is indispensable for effective shared decision making between the patient and surgeon. The International Neural Monitoring Study Group (INMSG) feels complete discussion of IONM in the preoperative planning and patient consent process is important in all patients undergoing thyroid and parathyroid surgery. The purpose of this publication is to evaluate the impact of IONM on the informed consent process before thyroid and parathyroid surgery and to review the current INMSG consensus on evidence-based consent. The objective of this consensus statement, which outlines general and specific considerations as well as recommended criteria for informed consent for the use of IONM, is to assist surgeons and patients in the processes of informed consent and shared decision making before thyroid and parathyroid surgery.

Enhancing the Informed Consent Process Using Shared Decision Making and Consent Refusal Data from the CLEAR III Trial

2019 ◽  
Vol 32 (1) ◽  
pp. 340-347
Author(s):  
Amanda L. Porter ◽  
James Ebot ◽  
Karen Lane ◽  
Lesia H. Mooney ◽  
Amy M. Lannen ◽  
...  
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Informed Consent Process ◽  
Consent Process ◽  
Shared Decision

Abstract 276: A Qualitative Analysis of Shared Decision Making in Cardiac Surgery

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Ryan Gainer ◽  
Karen Buth ◽  
Jennie David ◽  
Rose Garson ◽  
Hani Mufti ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Informed Consent ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Institutional Care ◽  
Consent Process ◽  
Patient Specific ◽  
Shared Decision ◽  
Patient Groups

OBJECTIVES Comprehension of risks, benefits, and alternative treatment options is poor among patients referred for cardiac interventions. We have previously demonstrated that frail, elderly patients undergoing cardiac surgery require complex procedures and are at markedly increased risk of postoperative death and prolonged institutional care. An effective informed consent process is critical in this population. We suggest this vulnerable patient population may benefit from the institution of a formalized shared decision making (SDM) process. METHODS Three focus groups were convened for CABG, Valve, or CABG +Valve patients over 70 who were either within two years post-op, within 4-8 weeks post-op or had had a complicated post-operative course. Two focus groups were convened for the caretaker group: IMCU nurses & ICU nurses and surgeons, anesthesiologists & cardiac intensivists. In a semi-structured interview format, groups were asked questions regarding personal experience with informed consent, comprehension of discussions prior to surgery, potential improvements to the consent process, and SDM in cardiac surgery. Transcribed audio data was analyzed to develop consistent and comprehensive themes. RESULTS Patient groups were supportive of changing standard consent by including patient-specific risk factors through graphics, reduced language complexity and increased font size as means to improve comprehension and discussion. Patient groups felt access to this information earlier on in their care would allow time to identify personal values and desires for treatment. Both care provider groups supported a consent process that would provide patients with information earlier through decisional aids presented in a structured SDM process. All groups were supportive of a dedicated RN employed as a decisional coach to meet with patients and families prior to surgery to discuss their values, concerns, and questions to facilitate SDM with the care team. CONCLUSIONS Data from these groups will aid in the development of decision aids that serve to educate patients about their disease, the procedure proposed, and its risks and alternatives. Utilizing validated risk prediction models from our own experience allows us to provide patient specific risks for in-hospital mortality, major morbidity, and prolonged institutional care as well as long term outcomes freedom from mortality and re-hospitalization for cardiac cause.

Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law

2017 ◽  
Vol 45 (1) ◽  
pp. 12-40 ◽  
Author(s):  
Thaddeus Mason Pope
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Legal Doctrine ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Decision Making Processes

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

Das präoperative anästhesiologische Patientengespräch

2009 ◽  
Vol 66 (7) ◽  
pp. 503-508 ◽  
Author(s):  
Christoph Harms ◽  
Christoph H. Kindler
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision

Anästhesisten treffen ihre Patienten häufig in Ausnahmesituationen an, geprägt von Angst und großer Unsicherheit. Selbst zeitlich kurze Kontakte sind daher meist intensiv und bedeutsam. Das persönliche, anästhesiologische Gespräch steht am Beginn der Beziehung von Patient und Anästhesist und soll die geplanten Maßnahmen, welche der Anästhesist durchführen wird, erklären und begleiten. Ein solches Gespräch dauert heute durchschnittlich 20 Minuten. Es beinhaltet die Erhebung der Anamnese, die strukturierte und verständliche Informationsübermittlung zwischen Anästhesist und Patient (inklusive Informationen über die anästhesiologischen Interventionen, Instruktionen zum Verhalten des Patienten und die offene und klare Kommunikation von Vor- und Nachteilen sowie Risiken möglicher Anästhesieverfahren) sowie den professionellen Umgang mit den Emotionen des Patienten, insbesondere seiner präoperativen Angst. Da Patienten heute in der Anästhesiologie vermehrt in den Entscheidungsprozess mit einbezogen werden, entwickelt sich dieses Gespräch zunehmend von einer eher paternalistischen Arzt-Patienten Interaktion zu einer gemeinsamen Entscheidungsfindung, dem so genannten „shared decision making“. Formal sollte das präoperative Gespräch die bekannten Voraussetzungen für eine erfolgreiche Verständigung zwischen Patient und Arzt wie Deutlichkeit, Eindeutigkeit, identische Kodierung, Empathie und Rückmeldung erfüllen und mit dem einholen eines „informed consent“ enden.

scholarly journals Principles for screening: Too few concerns for informed consent and shared decision-making?

2018 ◽  
Vol 190 (37) ◽  
pp. E1115-E1115 ◽  
Author(s):  
Alain Braillon ◽  
Philippe Nicot ◽  
Cécile Bour
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision
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