March 1997

Parental desire for perioperative information and informed consent: A two-phase study.
Kain ZN, Wang, SM, Caramico LA, Hofstadter M, Mayes LC. Anesth Analg 1997; 84: 299-306.
[ see abstract below ]

The purpose of this study was to identify the perioperative information that parents desire from the anesthesiologist and to determine whether the provision of detailed anesthetic information is associated with increased parental anxiety. In phase I, data were collected on the information that parents want from the anesthesiologist about the perioperative period. Information was also collected from the parents of 334 children regarding situational anxiety, coping strategy, and temperament. In phase II, 47 parents were randomly assigned to receive either routine anesthetic risk information (control), e.g. "other complications are more serious but occur much less frequently" or detailed anesthetic risk information (intervention), e.g. "brain damage occurs in 1:80,000 patients; death occurs in 1:200,000 patients".

Parental anxiety was assessed immediately prior to the anesthetic interview, then after assignment to the detailed or routine group and after the anesthetic interview, they were again evaluated regarding anxiety. Parents were again evaluated on the day of surgery and at the time their child entered the operating room. Parents educational level was associated with an increased desire for information (P<0.05). There was no difference between groups regarding level of anxiety at any of the four time periods. The majority of the parents (>95%) preferred to have comprehensive information concerning their child's perioperative period, including information about all possible complications.

This is an interesting study which confirms my personal bias which is that parents want to be informed about what we as the anesthesiologist are going to do to take good care of their child and to provide information regarding risks. I very much agree with the authors' conclusion that informed consent should strike a middle ground between providing details regarding "significant" risks while considering the individual needs for each patient. It is most interesting that very detailed information regarding what might go wrong under anesthesia was not associated with increased parental anxiety. Unfortunately, the authors were not able to demonstrate a reduction in anxiety with increased information. Informed parents, I believe, actually make for calmer parents and calmer parents make for a calmer child. I would love to see these investigators examine that interaction! This is a very important issue, but a very difficult one to study objectively.

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ABSTRACT