Radiology trainees often fall short in informed consent processes for IR procedures
Informed consent conversations conducted by radiology trainees before interventional procedures frequently lack essential details, according to new research.
Published in Academic Radiology, the findings are derived from patient experience questionnaires conducted before giving consent for core liver biopsies and then again after the procedure concluded. Experts involved in the analysis say the results highlight the need for better training in risk communication and patient engagement among trainees early in their careers.
“Performed well, informed consent can establish rapport and trust, and provide a clear and realistic basis to assess risk and appropriately modulate apprehension and fears,” Mark A. Kliewer, MD, with the department of radiology at the University of Wisconsin-Madison, and colleagues noted. “Performed poorly, it can inadvertently arouse exaggerated fears, anxiety, and dread, and heighten the subsequent perception of pain. At worst, it can become an exercise characterized by undue influence, inadequate patient engagement, or dismissal of patient concerns.”
To get a better idea of radiology trainees’ competence at pre-procedure consent practices, researchers analyzed 50 recorded patient consent conversations to assess their content, completeness and presentation. The team also evaluated patients’ anxiety, confidence and pain perceptions before consent and after the procedure, as well as whether trainee characteristics might have influenced their consent practices.
Researchers assessed conversations using three levels of completeness based on published standards. Qualitative content analysis was used to identify patterns in how trainees discussed informed consent.
Only 27 of the 50 conversations (54%) met the study’s criteria for basic completeness. Eight conversations (16%) reached the intermediate level, while just one (2%) met the criteria for advanced completeness.
Despite the observed gaps in consent discussions, patients reported no changes in anxiety, confidence or pain perceptions between the pre-consent assessment and the post-procedure evaluation. Researchers also found no attributable effects related to trainees’ age, sex, postgraduate year or race.
The authors concluded that consent discussions for core liver biopsies, as currently conducted by trainees, are often incomplete and lack substance. They suggested that improving education in consent content, risk framing and patient engagement could help trainees develop more effective communication practices.
“Supervising radiologists should not assume that their trainees know how to obtain a complete and sufficient informed consent,” the research group wrote. “Once trainees demonstrate their ability to present the basic elements of consent, then that presentation could be shaped and shaded so as to provide essential information and, at the same time, instill confidence and reassurance at levels commensurate with the actual risks of the procedure.”
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.