Surgical consent of children and guardians for the treatment of adolescent idiopathic scoliosis is incompletely informed

Study Design. Prospective, multicenter cohort analysis. Objective. Assess children and guardian's comprehension of surgical consent for adolescent idiopathic scoliosis (AIS) surgery and factors associated with their comprehension. Summary of Background Data. Informed consent is essential to the ethical practice of surgery. Little is known about how informed are children and guardians when consenting to operation for AIS. Methods. Guardians and their children (10-18 yr) undergoing spinal fusion for AIS were prospectively evaluated at 4 institutions. Each child and guardian was asked to complete a questionnaire of the risks, benefits and expected results of operative treatment and a self-assessment of overall comprehension. A site-survey questionnaire regarding teaching methods, timing between teaching and consent, and healthcare provider involved in the consent process was also used. Significance was assessed using logistic regression examining factors associated with good (-6 scores correct) and poor (<6 scores correct) comprehension. Results. One hundred seventy six pairs of patient/guardian were enrolled. Fifty-seven patient/guardian questionnaires were discarded due to incompleteness. A greater percentage of guardians had good overall comprehension of the surgical consent (patients: 59.7%; guardian: 71.4%). Post-operative mobility (patient 31%; guardian 42%) was poorly understood. Surgical risks (i.e., neurologic injury, infection, hardware failure, future sequelae) were modestly understood (40-70% correct). Factors associated with better understanding were older patient age (>12 yr), guardian with a college degree, obtaining consent by the attending surgeon and at a separate preoperative visit than the time of teaching, the use of visual aids, and participation in a "peer-support group" preoperatively. There was a trend toward guardians' and patients' self-assessment of understanding mirroring their respective objective performances. Discussion. Patients who undergo surgical intervention for AIS and their guardians understand approximately 60% of the surgical consent. The use of preoperative multimodal teaching techniques and "peer-support groups" may improve patient and guardian comprehension.