A novel method to enhance informed consent: a prospective and randomised trial of form-based versus electronic assisted informed consent in paediatric endoscopy.
OBJECTIVE
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.
Division of Gastroenterology, Department of Pediatrics, Doernbecher Children's Hospital, Center for Ethics in Health Care, Oregon Health and Science University, 707 SW Gaines Street, Mailcode CDRCP, 707 SW Gaines Street, Portland, OR 97239, USA. friedlan@ohsu.edu
Joel A
JA
Friedlander
Greg S
GS
Loeben
Patricia K
PK
Finnegan
Anita E
AE
Puma
Xuemei
X
Zhang
Edwin F
EF
de Zoeten
David A
DA
Piccoli
Petar
P
Mamula
D002648:Child; D003142:Communication; D003201:Computers / Q000706:statistics & numerical data*; D032962:Consent Forms / Q000706:statistics & numerical data*; D004724:Endoscopy; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires