Join now to get access to this content and more.
Become a SOAP member and have access to our benefits.
- For Review: SOAP Consensus Statement on Neuraxial Procedures in Thrombocytopenic Parturients
- Sample Centers of Excellence Applications
- ASA Corner
- SOAP Policy and Procedure Manual (P&P Manual)
- SOAP Expert Opinions
- SOAP's Learning Modules
- 2019 Annual Meeting Lecture Videos
- December 2018 - SOAP Unofficial Guide to ASA Committees Webinar
- Submit a Position
- View Job Postings
- Previous Meeting Archives
- Previous Meeting Abstract Search
- CMS Guidelines
- Member Benefits
- Newsletter Clinical Articles
- ACOG Documents
- Search our Patient Safety Archive
- Ask SOAP a Question
- Global Health Opportunities
- And more…
The Informed Consent Process for Labor Epidural Analgesia: A Prospective Survey of Patient Comprehension and Satisfaction
Abstract Number: S 2
Abstract Type: Original Research
Women experiencing labor pain have been shown to retain the capacity to provide informed consent (1). However, patient and provider surveys have demonstrated wide variability in what information is disclosed to patients, its source, and what is retained (2,3). Although retention does not always correlate with comprehension, it serves as a surrogate for adequacy of informed consent. At our institution, the labor epidural consent process involves discussion of risks, benefits, and alternative modes of pain relief. However, the timing of the process is variable: women may be consented prior to labor onset, while in early labor, or immediately prior to placement of the labor epidural.
1. Assess whether patients felt they received sufficient information to give informed consent and evaluate their satisfaction with the current consent process.
2. Assess whether patients understood the key risks and side effects associated with labor epidurals and determine if timing of consent in relation to timing of epidural placement is an independent factor for such understanding.
Patients who received epidural analgesia for labor and vaginal delivery were approached for study participation on postpartum day one. After IRB approval and verbal consent, a standardized survey was collected prospectively by a single investigator. Of note, the epidural consent was obtained per standard of care by multiple providers and was not controlled.
Patient surveys were divided into 3 groups based the time interval between consent to epidural placement: Group 1 – immediate, Group 2 – < 3 hours and Group 3 – > 3 hours. Retention scores were calculated from responses to 10 questions regarding risks and complications, and reported as a percentage (0-100% scale). An interim power analysis calculated a sample size of 183 (61 per group) to detect a clinically important difference in total retention scores among the three groups using one-way ANOVA.
Out of 83 patients approached, 65 completed the survey. Preliminary analysis showed that 97% of patients were satisfied with the process and felt they received sufficient information to provide informed consent. There was a trend towards greater retention of information among women who were consented earlier in their labor (group 1: 66.9 ± 16.4 %; group 2: 68.8 ± 12.0 %; group 3: 72.3 ± 14.4 %; p value 0.56) although it was not significant. Recruitment and analysis is ongoing.
Prospective survey of postpartum patients in our institution who received labor epidurals indicates high level of satisfaction with the consent process. Our preliminary results suggest that patients consented earlier in labor have greater retention of information. Further survey collection may confirm this finding.
1.Affleck PJ,et al.J Clin Anesth 1998;10:141-4
2.Jackson A,et al.Can J Anaesth 2000;47:1068–73
3.Bethune L,et al.Int J Obstet Anesth;2004;13:30-4