Doctor-patient communication in pediatrics. Need for improvement in routine informed consent

Background. The active participation and inclusion of children in informed consent discussions is crucial for improved compliance, reduction of stress and anxiety as well as a better outcome for the children. Aim. The objective of this study was the analysis of doctor-patient communication in pediatrics ahead of small or moderately difficult interventions. Methods. Pediatric informed consent procedures were examined with a mixed methods design consisting of interviews with 6 experts, recording of 16 disclosures and subsequent 16 patient interviews as well as 16 parent questionnaires. Results. Pediatric informed consent discussions can be influenced by multiple factors but they are only one of many conversations which take place during the hospital stay or outpatient visit. They are, in the context of preliminary talks, defined as a process. In the recorded disclosures the decisions were already made and the patient's capacity to consent was not assessed although this is important for attaining informed consent and informed assent standards. More experienced patients were less likely to be informed about risks even though they need the same information as inexperienced minors. The result was that these patients often had more problems with summarizing the planned interventions than expected. Conclusion. Although the majority of the families were satisfied with the information procedure and the experts believed that the pediatric disclosures were suitable for children, there is still room for improvement in the form of children's involvement, the use of additional tools to explain particular issues as well as the explanation of risks.