Zeitschrift für klinische und experimentelle Dermatologieforschung
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What Form of Informed Consent? A Nationwide Pilot Survey

Benjamin K Stoff, Lauren C Payne, Jennifer Shih, Emir Veledar and Suephy C Chen

Background: Informed consent practices in dermatology are unknown.
Objective: Assess informed consent practices and opinions regarding minimum standards of care for dermatologic procedures.
Methods/materials: 500 randomly-selected, American dermatologists received mailed surveys, listing 19 dermatologic procedures. For each procedure, responders selected the informed consent method-none, verbal only, written only, or written and verbal representing their usual practice and opinion regarding minimum standard of care.
Procedures were grouped into: Destruction of non-malignant lesions, biopsy, electrodessication and curettage (ED&C), cosmetic, and excision (including Mohs surgery).
Results: Among 97 responders, mean age (SD) was 50 years (10.7). The most common informed consent practice (*) and opinion regarding standard of care (+) was verbal only for destructive procedures (66.5%*, 67.8%+), biopsy(46%*, 55.7%+), and ED&C (49.6%*, 53.9%+). Written and verbal informed consent was most common for excision (62.1%*, 41.1%+) and cosmetics (70.7%*, 51.6%+). No consent was in frequent (6.2% of responses), more common for destruction (11.9%) than biopsy (5.8%), ED&C (6.6%), cosmetic (3.3%) or excision (2.9%) (p=0.0002). Multivariate regression analysis revealed factors predicting no consent (odds ratio>5, 95% confidence interval) including practice <5 years (234.9, 11.2-999.9), surgical subspecialty (8.7, 2.9-25.8), solo private practice (14.7, 1.2-200), and destructive procedures (10, 3-33.3). Informed consent practice responses frequently equaled opinions about minimum standard (78.7%). Factors predicting practice exceeding opinion (estimate, p-value) included practice in Western US (-0.35, <0.0001) and academia (-0.67, <0.0001), practice >25years (0.16, 0.018), and history of malpractice litigation (-0.13, 0.008).
Conclusion: Numerous factors influence informed consent practices and opinions, including procedure type.