Aligning Patient-Provider Expectations for Informed Consent

Aligning Patient-Provider Expectations for Informed Consent

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Accreditation/Designation Statements

In support of improving patient care, Boston Children's Hospital is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for the healthcare team.

Physician

Boston Children's Hospital designates this live activity for a maximum of 2.5 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.

About

Communication for informed consent is vital for patients, families, and providers. Yet, it is often inadequate, resulting in poorly aligned expectations for a surgery, procedure, or course of treatment. The pre-operative encounter represents a particular challenge for surgeons, who often have limited time to establish relationships and trust with patients and families. This can result in misaligned expectations between patients, families, and providers. Such mismatch can lead to frustration, anger, and potentially litigation. 

This course focuses on improving communication and relational skills during the informed consent process to better align provider and family expectations, with a specific focus on surgical informed consent.

Course Format

Build on the pedagogy of the Institute for Professionalism and Ethical Practice's successful Program to Enhance Relational and Communication Skills (PERCS), this innovative, self-paced course is structured into five modules that include:

  1. Introduction: From Informed Consent to Aligning Expectations
  2. Parents' and Clinicians' Views on Pediatric Surgical Informed Consent
  3. Further Considerations for Aligning Expectations
  4. A Case Example: Enactment of a Pre-Surgical Conversation
  5. Learning from the Course

The lessons include:

  • Research on why informed consent is problematic for patients, providers, and insurers
  • Differences in expectations for surgical informed consent from the perspectives of experienced patients, families, and providers
  • Realistic enactment of a pre-surgical consultation to align expectations, featuring professional actors and real clinicians
  • Didactics and practical tips on how to better align patient, family, and provider expectations

Instructional Time

3 hour, 00 minutes

Statement of Need

Inadequate communication during the informed consent process can lead to surgeons, patients, and families having misaligned expectations. A surgical outcome that is perceived as successful by the physician may be experienced as a failure by the patient and family. Misaligned expectations of surgery can result in frustration, anger, and potentially litigation. This course aims to support clinicians to be better prepared to align expectations with patients and families during the informed consent process. 

Target Audience

  • Articulate patient, family, and provider perspectives regarding the importance of enhanced communication around informed consent
  • Explain the distinction between informed consent as a form to be completed and a process for aligning expectations
  • Utilize strategies for aligning expectations to enhance the effectiveness of informed consent practices

Expiration Dates

  • Released: March 26th, 2018
  • Reviewed: March 26th, 2018
  • Expires: March 26th, 2020

Course Format

Self-paced, using text and video, with post-test assessments. Requires 80% or higher score to earn CME credit. Online course assessment. Requires Safari (v6 or higher), Chrome (v38 or higher), Internet Explorer (v11 or higher), or Firefox (v23 or higher).

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Learning Objectives

  • Describe the pathophysiology of traumatic brain injury and intracranial compliance
  • Describe physiologic targets for the management of the injured brain
  • Explain therapies used to manage increased intracranial pressure and target optimal cerebral perfusion pressure
  • Describe the various clinical presentations of children with abusive head trauma
  • Describe the various mechanisms of injury that may cause abusive head trauma
  • Recognize imaging patterns on CT and MRI that are suggestive of abusive head trauma
  • Understand the characteristics of retinal hemorrhages in the setting of abusive head trauma

Contributors

                                                                                                                                                                                                                           

Donna Luff, PhD

Associate Director IPEP

Instructor in Anesthesia, Harvard Medical School

 

Craig Lillehei, MD

General Surgeon, Associate Professor of Surgery, Harvard Medical School

 

Rosella A. Micalizzi MSN, RN, CPNP-PC

Pediatric Nurse Practitioner Colorectal and Pelvic Malformation Center

Boston Children's Hospital

 

Stephen Brown, MD

Director

Associate Professor of Radiology, Harvard Medical School

Institute for Professionalism and Ethical Practice

Anesthesia, Division of Critical Care

Disclosures

In accordance with the disclosure policy of Boston Children's Hospital and the standards set forth by the Accreditation Council for Continuing Medical Education, course planners, speakers and content reviewers list below any relevant relationships they or their spouse/partner have to companies producing, marketing, re-selling or distributing health care goods or services consumed by or used on patients.

Instructor Disclosures

No disclosures to report:

Donna Luff, PhD; Craig Lillehei, MD; Rosella A. Micalizzi MSN, RN, CPNP-PC; Stephen Brown, MD; Luke Sato, MD; Melissa Cousino, PhD; Adena Cohen-Bearak, M.Ed., MPH; Aimee Williamson; Valerie Fleishman; Lisa Burgess; David Diamond; Scellig Stone; Ellen O'Donnell; Tish Reidy; Terry Buchmiller; Frances South; Katherine South; Tyson Ortiz; Viviane Nasr, MD; Lauren Mednick, PhD; Elaine C. Meyer, RN, PhD

Content Reviewers

No disclosures to report:

Richard Blum, MD, MSE, FAAP; Pamela H. Varrin, PhD; Caleb Nelson, MD, MPH; Christine Rachwal, RN, MSN, CCRN; Erin Ward, MsEd; David Waisel, MD

CME Content Reviewers

No disclosures to report:

Lesley Niccolini; Greg Durkin

Commercial and Financial Support Disclosure

This program receives no commercial support.