Informed proxy consent: Communication between pediatric surgeons and surrogates about surgery

Objective. Informed consent for surgical procedures requires that the proce dures are explained and that the patient understands the procedures and ris ks and agrees to undergo them. Proxy consent occurs when an individual is p rovided with the legal right to make decisions on behalf of another. This s tudy was conducted to determine how surgeons communicate information to obt ain an informed proxy consent, and to investigate how that information is r eceived and processed by surrogates responsible for providing such consent. Study Design. Twenty English-speaking parents or legal guardians and 5 surg eons in an urban pediatric hospital were interviewed before, and 2 to 4 wee ks after, the surgical procedure. In addition, the interview between the su rgeon and surrogate, when consent was obtained, was audiotaped and subseque ntly analyzed. Semistructured interviews were used to elicit the motivation s and influences on the surrogates to consent to the procedure. The same me thodology was used to elicit the corresponding impressions of the surgeons. The data were analyzed using descriptive statistics and cross-tabulations. 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 bel ief of surgeons, surrogates consulted with a variety of others, including m edical and paramedical professionals, family members, and spiritual leaders . Conclusions. Communication plays an important role within the surrogate-sur geon dyad. Psychologic variables such as expectations, and the perception o f both the surrogates and the surgeons, influence the amount of information that is proffered and the manner in which it is received. Improved communi cation may be achieved by use of visual aids, discussion of anesthesia and the postoperative course, recognition of the circumstances around the discu ssion, such as timing and location of the discussion, and personalization o f the discussion.