PEDIATRICS Vol. 105 No. 3 March 2000, pp. 591-597

Informed Proxy Consent: Communication Between Pediatric Surgeons and Surrogates About Surgery

Received Dec 2, 1998; accepted Jun 18, 1999.

Myrna Lashley^*, William Talley^*, Larry C. Lands, and Edward W. Keyserlingk^§

From the Departments of ^* Counselling Psychology, Faculty of Arts and Science, and  Pediatrics; and the ^§ Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.

Objective.  Informed consent for surgical procedures requires that the procedures are explained and that the patient understands the procedures and risks and agrees to undergo them. Proxy consent occurs when an individual is provided with the legal right to make decisions on behalf of another. This study was conducted to determine how surgeons communicate information to obtain an informed proxy consent, and to investigate how that information is received and processed by surrogates responsible for providing such consent.

Study Design.  Twenty English-speaking parents or legal guardians and 5 surgeons in an urban pediatric hospital were interviewed before, and 2 to 4 weeks after, the surgical procedure. In addition, the interview between the surgeon and surrogate, when consent was obtained, was audiotaped and subsequently analyzed. Semistructured interviews were used to elicit the motivations and influences on the surrogates to consent to the procedure. The same methodology was used to elicit the corresponding impressions of the surgeons. The data were analyzed using descriptive statistics and crosstabulations.

Results.  Demographic data did not influence the results. Although there was concordance between the surrogate's understanding of the procedure and the surgeon's impression of this understanding, only 3 of 17 surrogates could recall any specifics of the explained procedure. Contrary to the stated belief of surgeons, surrogates consulted with a variety of others, including medical and paramedical professionals, family members, and spiritual leaders.

Conclusions.  Communication plays an important role within the surrogate-surgeon dyad. Psychologic variables such as expectations, and the perception of both the surrogates and the surgeons, influence the amount of information that is proffered and the manner in which it is received. Improved communication may be achieved by use of visual aids, discussion of anesthesia and the postoperative course, recognition of the circumstances around the discussion, such as timing and location of the discussion, and personalization of the discussion.  Key words:  surrogate, surgical procedure, informed consent.

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