Material risk: a review of informed consent in the UK

Consent is a requirement for any medical or surgical intervention to be deemed appropriate. For such consent to be considered valid, it must be given voluntarily, by an individual with capacity, who has the appropriate information available to make an informed decision in line with their values. Following the Montgomery vs. Lanarkshire ruling in 2015, the legal basis from which informed consent is measured has changed. The law now reflects pre-existing professional guidelines, and advocates a patient-centred approach to informed consent. The previously paternalistic focus of informed consent, whereby it was deemed a matter for clinical judgement, has been firmly abandoned in favour of the provision of information pertaining to ‘material risks’, as determined by the significance attached to these risks by the patient themselves. This paper serves to provide an overview of consent within the medical profession, and gives an account of the implications of this landmark ruling.     

Dentist-patient relationship and quality care 4. Professional information and informed consent

As patients become relatively more knowledgeable on health issues and more aware of their rights, they become more concerned about receiving professional information and making informed choices. A healthy decision-making process can only be achieved through clear information and fair discussions. Thus, rather than signing a form, quality information for patients and the process of informed consent need to be considered as integral elements of a treatment alliance, a fair dialogue, quality oral care and a sign of respect for patients' rights for self-determination.     

Informed consent in dental practice: experiences of Dutch patients

AIM: To assess experiences of the Dutch population concerning the implementation of some of their rights by dentists. METHOD: A postal questionnaire. PARTICIPANTS: All 1,616 participants of the 'Consumer Panel Health Care' in the Netherlands. RESULTS: 78.8% of the subjects responded. Patients were satisfied with the general information they received from their dentist. Their experiences of receiving information about specific legislation-related issues, however, were less positive. A considerable percentage of patients indicate that their dentist did not always inform them about risks or alternative treatment options. CONCLUSION: The autonomy of patients, which is the key principle underlying the 1995 Medical Treatment Contract Act, can seriously be undermined without making available this kind of information.     

Good ethical practice in the dental treatment of patients with HIV/AIDS

Patients with HIV/AIDS have challenged the ethics of the dental profession. The seriousness, infectious character and social stigma of the illness have led to a range of ethical dilemmas about the treatment of such patients. This paper attempts to resolve some of the more difficult questions through exploring the moral boundaries of the rights and duties of both patients and dental practitioners. To accomplish this aim, the moral foundation for the general clinical duties of care is outlined, especially the obligations of providing treatment to a high standard, respecting the rights of patients to informed consent and doing both without personal prejudice. After illustrating why these duties require moral character as well as intellectual understanding, their practical consequences are outlined for specific issues in the treatment of seropositive patients. It is argued that patients should never be tested without their informed consent and that dentists have a duty to display courage, sensitivity and rigorous respect for confidentiality in the treatments they offer. The obligations of seropositive dentists are also considered, including their own obligations for disclosure toward regulatory authorities and patients. The moral debt which the dental profession owes to seropositive patients is highlighted.     

Predictors of fixed orthodontic treatment in 15-year-old adolescents in South Australia

Abstract An understanding of the determinants of the provision of fixed orthodontic treatment would be beneficial in the planning of any system aimed at rationalising supply. The aim of this longitudinal study was to determine those factors which were predictive of the provision of fixed orthodontic treatment in adolescents. Baseline data, at age 13 years, on oral health, the history of orthodontic consultation and interceptive orthodontic care, a dental appearance score (DAI), socio-demographic characteristics and self and parental perceptions of both dental appearance and need for fixed orthodontic treatment were obtained from 2793 adolescents under the care of the South Australian School Dental Service who had not undergone fixed orthodontic treatment. Data on the orthodontic care provided to these adolescents in the ensuing 2 years were collected. At the end of the 24-month period 433 adolescents (15.5%) had undergone fixed orthodontic treatment. Significant bivariate associations were found between the provison of fixed orthodontic treatment and the DAI score, sex of the adolescent, familial history of fixed orthodontic treatment, income, private insurance, orthodontic consultation and interceptive orthodontic care before the age of 13 years and self and parental perceptions of both dental appearance and the need for fixed orthodontic treatment. Logistic regression was used to produce a predictive model of fixed orthodontic treatment. The model explained 30.2% of the variance, with a specificity of 0.94, a sensitivity of 0.49 and a hit rate of 0.84%. Odds ratios greater than one were found for the DAI score, private insurance, females, self and parental perception of need, higher incomes and orthodontic consultation and interceptive orthodontic care before the age of 13 years.     

Predictors of orthodontic residency performance: An assessment of scholastic and demographic selection parameters

Objective:To evaluate the association between resident selection criteria, including Graduate Record Examination (GRE) scores, and student performance in an orthodontic residency program.Materials and Methods:This retrospective study evaluated the academic records of 70 orthodontic residency graduates from the Indiana University School of Dentistry. The following demographic and scholastic data were extracted from the student academic records: applicant age, gender, ethnicity, race, country of origin, dental school graduation year, GRE score, and graduate orthodontic grade point average (GPA). In addition, student American Board of Orthodontics (ABO) written examination quintiles were obtained from the ABO. Scatterplots, analysis of variance, and correlation coefficients were used to analyze the data. Statistical significance was established at .05 for the study.Results:No associations were found with any component of the GRE, except with the quantitative GRE section, which displayed a weak association with ABO module 2 scores. Dental school GPA demonstrated weak correlations with all ABO modules and moderate correlations with overall and didactic orthodontic GPAs. When assessing demographic factors, significant differences (P < .05) were observed, with the following groups demonstrating higher performance on certain ABO modules: age (younger), race (whites), and country of origin (US citizens).Conclusions:Findings suggest the GRE has no association with student performance in an orthodontic residency. However, dental school GPA and/or class rank appear to be the strongest scholastic predictors of residency performance.     

Patient and parent understanding of informed consent in orthodontics.

In both medical and dental settings, researchers have found that patients do not adequately comprehend the information given during informed consent discussions, especially the less educated, low-income patients. Because of the importance of patient compliance with orthodontic treatment regimens, this study examined patient and parent understanding of the child's Phase I orthodontic treatment in a public dental clinic with ethnically diverse, low-income patients. Interviews were conducted with 29 children (ages 6-12) and their parents or guardians at the orthodontic case presentation appointment. The orthodontist explained the reasons for treatment, the orthodontic procedures to be used, the risks, the alternatives, and patient and parent responsibilities during treatment; the session was audiotaped. Interviews were conducted immediately after this discussion and the results compared with the orthodontists' presentations. In general, both children and parents recalled significantly fewer reasons for treatment (1.10, 1.66, and 2.34 items, respectively), procedures (1.55, 1.59, and 2.45, respectively), risks associated with treatment (0.66, 1.48, and 4.66, respectively), and responsibilities of the child during treatment (2.21, 2.07, and 3.38, respectively) than what the orthodontist had told them. They were also less likely to recall the reasons, procedures, and risks that were most frequently cited by the orthodontist. These findings raise concerns about the effectiveness of current informed consent techniques with public health populations, especially the low recall rates within 30 minutes of the case presentations. Low recall of risks by children and their parents, particularly for critical risks such as relapse, caries, and periodontal problems, raises concerns about treatment compliance, success, and more importantly, the effectiveness of the informed consent process itself. Future research should focus on methods to improve the informed consent process among children undergoing orthodontic treatment in a low-income population.     

Use of an educational video with mobile technology for the informed consent process: A randomised controlled trial on patients undergoing surgery for an impacted lower third molar

The purpose of this study was to determine whether audiovisual presentation of consent information would significantly improve patients’ postoperative recall of risks and complications regarding surgical removal of impacted lower third molars compared to the presentation of traditional written consent information. A randomised controlled study on 59 patients undergoing third molar removal was conducted. Patients in the intervention group (n = 30) viewed an educational video on risks and complications related to surgery using mobile tablets. Control-group patients (n = 29) received written information of the risks and complications. Patients’ postoperative recall of potential risks for dysesthesia of the lower lip and tongue, infection, and bleeding along with surgical complications of facial oedema, trismus, and pain were assessed using true-false tests. The effect of audiovisual information on postoperative recall of the risks and complications was determined by comparing accuracy scores between the intervention group and control group using the independent t-test. The intervention group was found to have significantly better recall scores of the potential risks and complications, due to much higher accuracy in their recall of bleeding and dysesthesia of the lower lip and/or tongue, compared to the control group [mean (SD) 4.70 (0.94) vs 3.76 (1.50), p = 0.003]. The use of an educational video played on mobile tablets rather than a written pamphlet may lead to better understanding of the informed consent process in patients.     

Legal aspects of orthodontic practice: risk management concepts. Excellent diagnostic informed consent practice and record keeping make a difference

In this and succeeding issues of the American Journal of Orthodontics and Dentofacial Orthopedics, factual risk management scenarios will be presented. These scenarios are based on composites of actual court cases that have been tried to verdict or decision. Valuable risk management lessons may be learned from careful analysis of the course of the events described. Please be advised that the standard of care determined in any case is specific for that jurisdiction and that set of facts as established by expert testimony for the prevailing party. Readers' comments may be addressed to Dr. Donald E. Machen, 5801 Beacon St., Pittsburgh, PA 15217.     

A review of the law of consent in dentistry

The development of the law of consent has led to much discussion within the dental literature as to how these changes might impact practice. The move from a practitioner‐focused standard of consent to a patient‐focused standard has altered the nature of the framework required to support a patient's decision‐making to avoid an allegation or finding of a negligent consent process. Contrastingly, there has been little in the way of exploration as to how the law of battery (in civil matters) and assault (in criminal cases), where consent is entirely absent, might apply to dentistry and the practice of the profession. This article considers the law of consent, using several key examples from dentistry, as well as providing an update of recent case law of relevance to dental practice.     

Children and informed consent: a study of children's perceptions and involvement in consent to dental treatment

AIM: The aim of the study was to find out to what extent children are involved in consenting to their dental care. METHODS: It was conducted using a structured interview with 60 8-13-year-old children. In the control group, verbal consent was given by the parent, whilst in the study group written consent was given by the parent and verbal assent by the patient. Interviews were conducted after dental treatment. RESULTS: The findings indicate that children in the study group felt they were more involved in deciding about their dental treatment compared with the control group. CONCLUSION: Children want to be more involved in consenting to their dental treatment.     

Informed consent in dental care and research for the older adult population: A systematic review

Background

Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue.