Surgical Consent of Children and Guardians for the Treatment of Adolescent Idiopathic Scoliosis is Incompletely Informed.
METHODS
Prospective, multicenter cohort analysis.


OBJECTIVE
Assess children and guardian's comprehension of surgical consent for adolescent idiopathic scoliosis (AIS) surgery and factors associated with their comprehension.


BACKGROUND
Informed consent is essential to the ethical practice of surgery. Little is known about how informed are children and guardians when consenting to operation for AIS.


METHODS
Guardians and their children (10-18 yr) undergoing spinal fusion for AIS were prospectively evaluated at 4 institutions. Each child and guardian was asked to complete a questionnaire of the risks, benefits and expected results of operative treatment and a self-assessment of overall comprehension. A site-survey questionnaire regarding teaching methods, timing between teaching and consent, and healthcare provider involved in the consent process was also used. Significance was assessed using logistic regression examining factors associated with good (≥6 scores correct) and poor (<6 scores correct) comprehension.


RESULTS
One hundred seventy six pairs of patient/guardian were enrolled. Fifty-seven patient/guardian questionnaires were discarded due to incompleteness. A greater percentage of guardians had good overall comprehension of the surgical consent (patients: 59.7%; guardian: 71.4%). Post-operative mobility (patient 31%; guardian 42%) was poorly understood. Surgical risks (i.e., neurologic injury, infection, hardware failure, future sequelae) were modestly understood (40-70% correct). Factors associated with better understanding were older patient age (>12 yr), guardian with a college degree, obtaining consent by the attending surgeon and at a separate preoperative visit than the time of teaching, the use of visual aids, and participation in a "peer-support group" preoperatively. There was a trend toward guardians' and patients' self-assessment of understanding mirroring their respective objective performances.


CONCLUSIONS
Patients who undergo surgical intervention for AIS and their guardians understand approximately 60% of the surgical consent. The use of preoperative multimodal teaching techniques and "peer-support groups" may improve patient and guardian comprehension.
*Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA †Department of Orthopaedic Surgery, Texas Scottish Rite Hospital, Dallas, TX ‡Research Center, Sainte-Justine University Hospital Center, Montreal, Québec §Department of Orthopaedic Surgery, Children's Hospital, Denver, CO.
Alexander A
AA
Theologis
Andres
A
Anaya
Coleen
C
Sabatini
Daniel J
DJ
Sucato
Stefan
S
Parent
Mark
M
Erickson
Mohammad
M
Diab
D000293:Adolescent; D000328:Adult; D002648:Child; D032882:Comprehension; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D010353:Patient Education as Topic; D011446:Prospective Studies; D012600:Scoliosis / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery*; D012647:Self-Assessment; D011795:Surveys and Questionnaires