title: Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites.
abstract: BACKGROUND
  Medical tourism, thought of as patients seeking non-emergency medical care outside of their home countries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and many are helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in making international medical care arrangements for patients. As a key source of information for these patients, brokers are likely to play an important role in communicating the risks and benefits of undergoing surgery or other procedures abroad to their clientele. This raises important ethical concerns regarding processes such as informed consent and the liability of brokers in the event that complications arise from procedures. The purpose of this article is to examine the language, information, and online marketing of Canadian medical tourism brokers' websites in light of such ethical concerns.
  
  
  METHODS
  An exhaustive online search using multiple search engines and keywords was performed to compile a comprehensive directory of English-language Canadian medical tourism brokerage websites. These websites were examined using thematic content analysis, which included identifying informational themes, generating frequency counts of these themes, and comparing trends in these counts to the established literature.
  
  
  RESULTS
  Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourism broker websites varied widely in scope, content, professionalism and depth of information. Three themes emerged from the thematic content analysis: training and accreditation, risk communication, and business dimensions. Third party accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, and discussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on the remaining ones. Terminology describing brokers' roles was somewhat inconsistent across the websites. Finally, brokers' roles in follow up care, their prices, and the speed of surgery were the most commonly included business dimensions on the reviewed websites.
  
  
  CONCLUSIONS
  Canadian medical tourism brokers currently lack a common standard of care and accreditation, and are widely lacking in providing adequate risk communication for potential medical tourists. This has implications for the informed consent and consequent safety of Canadian medical tourists.
authors.affiliation: Faculty of Medicine, University of Calgary, 2500 University Drive, NW, Calgary, Alberta, Canada.
authors.forename: Kali
authors.initials: K
authors.lastname: Penney
authors.forename: Jeremy
authors.initials: J
authors.lastname: Snyder
authors.forename: Valorie A
authors.initials: VA
authors.lastname: Crooks
authors.forename: Rory
authors.initials: R
authors.lastname: Johnston
mesh_terms: D002170:Canada; D002755:Choice Behavior; D015986:Confounding Factors, Epidemiologic; D003657:Decision Making; D019981:Health Care Sector / Q000941:ethics*; D006801:Humans; D033181:Information Dissemination / Q000941:ethics*; D007258:Informed Consent / Q000941:ethics*; D020407:Internet; D007802:Language; D008389:Marketing of Health Services / Q000941:ethics* / Q000592:standards; D057193:Medical Tourism / Q000941:ethics*; D012306:Risk; D009626:Terminology as Topic