Informed Consent Challenges: A Mixed-Methods Study of Hospital Ethics Consultations.

Q3 Medicine

Journal of Clinical Ethics Pub Date : 2025-01-01 DOI:10.1086/736146

Daniel R S Habib, Cristopher Naranjo, Alexander J Langerman

{"title":"Informed Consent Challenges: A Mixed-Methods Study of Hospital Ethics Consultations.","authors":"Daniel R S Habib, Cristopher Naranjo, Alexander J Langerman","doi":"10.1086/736146","DOIUrl":null,"url":null,"abstract":"AbstractIntroduction: Hospital ethics committees guide healthcare workers and patients through complex consent issues. Prior research highlights gaps in consent forms and information delivery, but little is known about real-world ethics consults on consent. This study examines common challenges in consent discussions and compares patient and consult characteristics of consent-related versus other consults.Methods: De-identified ethics consult notes and patient data from Vanderbilt University Medical Center, a quaternary care academic medical center (2014-24), were analyzed. Consults were classified as consent or nonconsent related. Chi-square, Fisher's exact, and Wilcoxon rank-sum tests compared characteristics, while logistic regression assessed associations between consent themes.Results: Among 4,127 ethics consults, 137 (3.3%) were consent related. Compared to nonconsent consults, consent consults involved more adult (96.4% vs. 84.2%, p = .005) and female (58.4% vs. 19.0%, p = .001) patients and were more often low in complexity (36.5% vs. 22.8%, p < .001). Common issues included capacity (65.0%), surrogate decision-making (46.0%), communication barriers (38.0%), treatment timing (29.2%), goals of care (20.4%), patient refusal (19.7%), and sensitivity/invasiveness concerns (13.1%). Capacity concerns increased the odds of surrogate decision-making issues (OR = 2.97, 95% CI: 1.51-6.30). Advance directive completion was linked to older age (p = .031) and goals-of-care discussions (50.0% vs. 17.5%, p = .018).Conclusion: Consent-related consults differ in patient demographics and complexity, with capacity, surrogate decision-making, and communication barriers as key concerns. This study provides actionable insights to improve consent protocols, patient-clinician interactions, and ethical decision-making.","PeriodicalId":39646,"journal":{"name":"Journal of Clinical Ethics","volume":"36 3","pages":"215-223"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Ethics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1086/736146","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

AbstractIntroduction: Hospital ethics committees guide healthcare workers and patients through complex consent issues. Prior research highlights gaps in consent forms and information delivery, but little is known about real-world ethics consults on consent. This study examines common challenges in consent discussions and compares patient and consult characteristics of consent-related versus other consults.

Methods: De-identified ethics consult notes and patient data from Vanderbilt University Medical Center, a quaternary care academic medical center (2014-24), were analyzed. Consults were classified as consent or nonconsent related. Chi-square, Fisher's exact, and Wilcoxon rank-sum tests compared characteristics, while logistic regression assessed associations between consent themes.

Results: Among 4,127 ethics consults, 137 (3.3%) were consent related. Compared to nonconsent consults, consent consults involved more adult (96.4% vs. 84.2%, p = .005) and female (58.4% vs. 19.0%, p = .001) patients and were more often low in complexity (36.5% vs. 22.8%, p < .001). Common issues included capacity (65.0%), surrogate decision-making (46.0%), communication barriers (38.0%), treatment timing (29.2%), goals of care (20.4%), patient refusal (19.7%), and sensitivity/invasiveness concerns (13.1%). Capacity concerns increased the odds of surrogate decision-making issues (OR = 2.97, 95% CI: 1.51-6.30). Advance directive completion was linked to older age (p = .031) and goals-of-care discussions (50.0% vs. 17.5%, p = .018).

Conclusion: Consent-related consults differ in patient demographics and complexity, with capacity, surrogate decision-making, and communication barriers as key concerns. This study provides actionable insights to improve consent protocols, patient-clinician interactions, and ethical decision-making.

查看原文本刊更多论文

知情同意的挑战：医院伦理咨询的混合方法研究。

摘要简介：医院伦理委员会指导医护人员和患者解决复杂的同意问题。先前的研究强调了同意表格和信息传递方面的差距，但对现实世界中关于同意的伦理咨询知之甚少。本研究考察了同意讨论中常见的挑战，并比较了患者和咨询人员的同意相关特征与其他咨询人员。方法：对美国范德比尔特大学医学中心（Vanderbilt University Medical Center）四级医疗学术中心2014-24年的去身份化伦理咨询记录和患者资料进行分析。咨询被分为同意或不同意相关。卡方检验、Fisher精确检验和Wilcoxon秩和检验比较了特征，而逻辑回归评估了同意主题之间的关联。结果：4127例伦理咨询中，137例（3.3%）与同意相关。与不同意咨询相比，同意咨询涉及更多的成人患者（96.4%对84.2%,p = 0.005）和女性患者（58.4%对19.0%,p = 0.001），并且复杂性更低（36.5%对22.8%,p < 0.001）。常见的问题包括能力（65.0%）、替代决策（46.0%）、沟通障碍（38.0%）、治疗时机（29.2%）、护理目标（20.4%）、患者拒绝（19.7%）和敏感性/侵入性问题（13.1%）。能力问题增加了替代决策问题的几率（OR = 2.97, 95% CI: 1.51-6.30）。预嘱完成情况与年龄（p = 0.031）和护理目标讨论（50.0%对17.5%,p = 0.018）有关。结论：与同意相关的会诊在患者人口统计和复杂性方面存在差异，能力、替代决策和沟通障碍是关键问题。本研究为改进同意协议、医患互动和伦理决策提供了可行的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Clinical Ethics Medicine-Medicine (all)

CiteScore

1.40

自引率

0.00%

发文量

期刊介绍： The Journal of Clinical Ethics is written for and by physicians, nurses, attorneys, clergy, ethicists, and others whose decisions directly affect patients. More than 70 percent of the articles are authored or co-authored by physicians. JCE is a double-blinded, peer-reviewed journal indexed in PubMed, Current Contents/Social & Behavioral Sciences, the Cumulative Index to Nursing & Allied Health Literature, and other indexes.