title: Assent for treatment: clinician knowledge, attitudes, and practice.
abstract: OBJECTIVE
  Our purpose for this work was to explore clinician knowledge, attitudes, and practice regarding assent for medical treatment and to compare current practice with existing American Academy of Pediatrics guidelines.
  
  
  METHODS
  One of the investigators administered a questionnaire to clinicians who perform procedures on children at an academic tertiary care pediatric hospital to assess knowledge of assent for medical treatment and familiarity with the American Academy of Pediatrics policy statement on assent and to measure clinician attitudes and approaches to consent/assent in pediatrics.
  
  
  RESULTS
  Of 35 clinicians enrolled, 23 (66%) had heard of the term "assent," and 9 (26%) of 35 were aware of the American Academy of Pediatrics policy statement on assent. Twenty five (74%) of 34 thought 1 of the main goals of assent was to educate the child. Only 12 (35%) of 34 included the element of seeking the child's agreement as a goal of assent. In practice, the element of explaining the proposed treatment was "always" included by 26 (74%) of 35. The element of seeking the child's agreement was "always" included by 9 (26%) of 35.
  
  
  CONCLUSIONS
  The clinicians in this study had limited explicit knowledge of the concept of assent for medical treatment and were largely unaware of the recommendations from the American Academy of Pediatrics. Their attitudes and practice reflected implicit acceptance of the importance of including children in discussions about their medical care and reluctance to give children decision-making authority. A model of medical decision-making for children that includes education but does not allow children to share decision-making authority may be more applicable to clinical practice than the current American Academy of Pediatrics-supported model of assent.
authors.affiliation: Departments of Pediatrics, bSurgery, and cAnesthesia, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. kjlee@mcw.edu
authors.forename: K Jane
authors.initials: KJ
authors.lastname: Lee
authors.forename: Peter L
authors.initials: PL
authors.lastname: Havens
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Sato
authors.forename: George M
authors.initials: GM
authors.lastname: Hoffman
authors.forename: Steven R
authors.initials: SR
authors.lastname: Leuthner
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003657:Decision Making / Q000941:ethics; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care; D028701:Patient Rights; D010361:Patients / Q000523:psychology*; D010372:Pediatrics; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D002666:Psychology, Child; D012955:Societies, Medical; D014342:Truth Disclosure