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The Content of Informed Consent for Neuraxial Analgesia
Abstract Number: T-61
Abstract Type: Original Research
Objective: Informed decision-making is a challenging task. Work in the outpatient setting has shown that <1% of complex decisions (e.g. procedural decisions) met criteria for completely informed decision making. The decision to use or not use neuraxial labor analgesia is a complex decision, as there are extensive effects to the patient, there is no consensus on the medical necessity of the procedure, and there are multiple possible outcomes for the patient. The purpose of this observational study was to evaluate the content of analgesic counseling for neuraxial labor analgesia.
Methods: Anesthesiology resident physicians and English-speaking nulliparous women, recruited after admission to the Labor and Delivery unit, participated in a study on patient-provider communication. The analgesic counseling session was audio-recorded and transcribed verbatim. A scoring matrix was developed, and each analgesic risk, benefit, and discussion of any alternatives was given one point. Count data were presented as percentages, and discussion content was compared among residents using a chi-square statistic. P < 0.05 was significant.
Results: Ten residents participated in this study. A total of 82 patient interviews were recorded, and each resident counseled between one and sixteen patients. During the counseling, 98% of residents mentioned risks, 95% mentioned benefits, and 21% mentioned alternatives to neuraxial analgesia. There was significant variability amongst residents in what specific risks and benefits were discussed with patients (Table 1).
Conclusion: While there are no formal guidelines as to what information needs to be discussed while obtaining informed consent for neuraxial analgesia, risks with an incidence of ≥1% should be disclosed, as well as risks with serious morbidity or mortality. In addition, benefits and alternatives should be discussed. Our results demonstrate that inconsistent information is being discussed with patients during analgesic counseling, and this may result in poor quality decision-making, as patients may not be truly informed. A more formal, standardized process for teaching informed consent should be developed and evaluated to improve the quality of analgesic counseling discussions.
Funding: Robert Wood Johnson Foundation grant 69779