Evolving perspective on informed consent
When I was working as a perioperative nurse in the hospital, the extent of my patient care role spanned only the duration of their surgery and my interaction with informed consent consisted of ensuring the required forms were signed and filed in the chart per hospital policy. When I started practicing as a nurse practitioner my perspective on informed consent shifted as I had the opportunity to participate in the entirety of a patient’s journey through surgery—from initial consultation to annual follow-ups. Since plastic surgery is a procedure-based specialty, informed consent is a central focus of my clinical practice.
Problems with informed consent and interest in improvement
I recognized several deficiencies in the informed consent process: namely, that it’s a systems problem, and the current system is set up to fail by relying on clinician vigilance. There is considerable variation in the depth, breadth, and quality of its content, presentation and delivery which I believe significantly contributes to miscommunication and poor patient understanding. Moreover, the culture of informed consent is that it’s a legal formality of a signature on a form. The focus is on clinician disclosure, not patient understanding, and is treated as an obligatory, ritualistic activity that is done to the patient, not with them. My increasing interest in informed consent and its challenges prompted me to return to my alma mater, Emory School of Nursing, to complete my doctorate in nursing practice.
During my doctoral program, I focused my scholarship on improving the effectiveness of the informed consent process in elective aesthetic procedures through an ongoing large-scale quality improvement initiative to replace traditional informed consent documents with certified patient decision aids (PDAs). No certified PDAs currently exist for elective aesthetic procedures, so for completion of my doctorate, I successfully defended an evidence-based, development process model for creating certifiable PDAs in this patient population. I presented this initial conceptual work at the Sigma Theta Tau International Creating Healthy Work Environments 2019 conference during the “Rising Stars of Research and Scholarship—Invited student posters” session. As a continuation of this project, a pilot study is underway using the model to create a prototype PDA for primary breast augmentation.
Interest in ethics
I have also recently published on ethical challenges with nonsurgical medical aesthetic devices which includes discussion on the influence of misinformation, including deceptive advertising, on informed consent.
Replace traditional informed consent documents with certified patient decision aids
Traditional informed consent documents and readily available patient education materials do more to contribute to patient confusion than comprehension. Certified patient decision aids are structured, evidence-based educational tools that can empower each member of the care team, including the patient, with quality and understandable information to better support informed consent discussions by reinforcing key learning points while also allowing for real-time documentation of progressive patient learning along the care trajectory.
Hagopian CO, Ades TB, Hagopian TM, Wolfswinkel EM, Stevens WG. Attitudes, beliefs, and practices of aesthetic plastic surgeons regarding informed consent [published ahead of print]. Aesthet Surg J. 2019. https://doi.org/10.1093/asj/sjz206