Informed consent for anesthesia: a review of practice and strategies for optimizing the consent process

Patients must receive information in a manner that promotes understanding so they can make informed decisions about anesthesia and other medical interventions. Unfortunately, history is replete with examples of the negative consequences of inadequate disclosure of information and lack of patient understanding. While obtaining consent for anesthesia poses unique challenges, the ability of the anesthesiologist to engage the patient in meaningful discussion is critical as a means to ensure that the patient is truly informed. This narrative review aims to: 1) discuss the process of informed consent as it applies to anesthesia practice; 2) describe the salient issues related to patient capacity, disclosure, understanding, decision-making, and documentation of the informed consent process; and 3) discuss current strategies to improve the presentation and understanding of consent information. Review of the extant literature, including the authors' own research. Despite the ethical imperative of informed consent, many decision-makers have limited understanding of medical information. The reasons for this are multifactorial but often result from incomplete disclosure and presentation of generic information that does not take into account differences in information needs, values, and preferences of individual patients. Several simple strategies are available, however, that can enhance decision-makers' understanding of both written and verbal information. Despite the unique challenges of obtaining consent for anesthesia on the day of surgery, attention to the manner in which information for anesthesia care is provided and adoption of simple strategies to enhance understanding can go a long way to ensure that decision-makers are appropriately informed.