Informed consent conversations conducted by radiology trainees are often incomplete and don’t meet predefined criteria, suggest findings published October 22 in Academic Radiology. 

Nearly half of trainee-led consent conversations did not meet the predefined criteria for basic consent completeness for patients undergoing ultrasound-guided core liver biopsy in a study led by Mark Kliewer, MD, and colleagues from the University of Wisconsin-Madison. 

“Greater attention to the consent process in radiology training may be needed more widely,” the Kliewer team wrote. 

Informed consent is both a legal and an ethical requirement before any invasive procedure, biopsies included. Consent conversations with patients are interpersonal in nature and involve trust, autonomy, shared decision-making, risk perception, and patient understanding of the risks and benefits of procedures. Poor messaging can heighten patient anxiety and distrust. 

Kliewer and co-authors recorded and characterized the content and wording of informed consent conducted by radiology trainees for ultrasound-guided liver biopsies. From there, they studied how this presentation affects the patient-reported anxiety, confidence, and pain. 

The study included 50 consent conversations. The team categorized consent completeness as either basic, intermediate, or advanced. It based these on published standards. 

The researchers reported the following findings: 

• Of the total conversations, 27 (54%) met the predefined criteria for basic consent completeness (the most essential elements). 

• Eight conversations (16%) met criteria for intermediate completeness. 

• One conversation (2%) met criteria for advanced completeness.  

• Patients reported no change in their anxiety, pain, or confidence from before the consent to after the procedure.  

“The most common deficiency was failure to discuss the purpose or benefits of the procedure,” the researchers wrote. 

The team did not observe any effect that could be attributed to trainees-level characteristics.  

They also noted that consent conversations were not well-detailed for evaluating risk framing strategies or for analyzing conversations. However, the researchers suggested some potential contributors, including limited formal instruction on informed consent, uncertainty about which elements should routinely be discussed, assumptions that healthcare providers had already explained the procedure, or workflow pressures tied to a busy procedural practice. 

“Supervising radiologists should not assume that their trainees know how to obtain a complete and sufficient informed consent,” the study authors wrote. “Once trainees demonstrate their ability to present the basic elements of consent, then how that presentation could be shaped and shaded so as to provide essential information and, at the same time, instill confidence and reassurance at levels commensurate with the actual risks of the procedure.” 

Read the full study here.