Experimenting Informed Consent---The Influences of Different Methods of Presenting Risk Information and the Match of Patient-Physician Information Preference on Risk Perception and Compliance Intentions

BACKGROUND: In recent years, informed consent and shared decision making have become an issue of priority to ensure the autonomy of patients in clinical encounters. The ethical and legal requirement to obtain informed consent prior to performing a procedure or administering a treatment derives from the concept of personal autonomy. The competent patient, after receiving appropriate disclosure of the material risks of the procedure or treatment, understanding those risks, the benefits, and the alternative approaches, makes a voluntary and uncoerced informed decision to proceed. However, the effectiveness and quality of informed consent remain controversial because the concept of informed consent should be seen as a process (mutual communication) rather than an event (document signing). Research, based on experimentation with the process of informed consent, is needed to improve the quality of informed consent. OBJECTIVES: The aims of the 2 studies described in this proposal were to investigate whether commonly used methods of conveying risk and patient-physician preference for information exchange might influence subjects' perceptions of their risk of undergoing proposed surgery or treatment and whether such factors might subsequently influence subjects’ intentions to comply with prescribed or suggested treatment. METHODS: In study 1, randomly selected patients who will undergo high-risk surgery and informed consents are required. They were surveyed to estimate the relationship among different methods of presenting risk information, subjects’ personal characteristics, risk perception, and satisfaction about physician-patient relationship. It is proposed to recruit 160 patients, among them half will undergo surgery with high certainty (e.g. laparotomy for accidental of abdomen) who are consented with risk information in terms of percentage. Another half with low certainty (e.g. Lumpertomy plus radiation) are presented with risk information in general semantic terms (eg, "some people may experience"). It is hypothesized that patients overestimated their risk and when information was disclosed semantically. The relationship is hypothesized to be mediated by the match degree of patient-physician preference for information. Study 2 is a randomized, controlled experiment in which we examine the causal relationship among the factors of study 1. A total of 160 university students will be recruited and randomly assigned to four groups and are presented with a simulating real-life clinical encounters where a doctor is giving informed conscent to a patient. The experimental conditions are divided according to the different four scenarios determined by the certainty of disclosed information: (high vs low) and physician’s communication preference (dominant vs friendly). CONCLUSIONS: The proposal aims to examine factors influence the process of informed consent. The results can be apply to improve informed consent strategies and match interventions, and if evidence continues to be supportive, may routinely optimize patient-physician encounters toward more positive outcomes.

Project ID:PF9801-1820
External Project ID:NSC97-2410-H182-005-MY2