Objective: To examine children’s and adolescents’ involvement in the informed consent conference for phase I cancer trials and test associations with patient age, ease of understanding, and pressure to participate.
Procedure: Participants included 61 patients aged 7 through 21 years who were offered participation in a phase I trial. Consent conferences were audiotaped, transcribed, and coded for communication between patients and physicians and between patients and parents.
Results: On the basis of word counts, the mean proportion of the consent conference in which the physician was talking to the patient was 36%; the vast majority (73%) of this communication consisted of giving information. Physician-patient communication increased with age, but overall levels of patient-to-physician communication were low (3%). After controlling for patient age, greater physician-to-patient communication was associated with greater ease of understanding.
Conclusions: The focus on providing information in the context of informed consent may come at the expense of other communication exchanges that are important to patients, especially in the context of end-of-life decisions. Children and adolescents may benefit from the assent process when physicians direct more of their communication to them. Future research should identify the reasons for low patient communication during the consent conference and strategies to enhance their participation in decision making about phase I trial enrollment.
*Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA
†Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN
‡Department of Bioethics
∥Center for Ethics, Humanities and Spiritual Care, Cleveland Clinic, Cleveland
§Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Supported by the National Institutes of Health (NIH) via the National Cancer Institute (NCI) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (1R01CA122217). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, NCI, or NICHD.
The authors declare no conflict of interest.
Reprints: Eric Kodish, MD, Center for Ethics, Humanities and Spiritual Care, Cleveland Clinic, 9500 Euclid Avenue JJ60, Cleveland, OH 44195 (e-mail: firstname.lastname@example.org).
Received July 8, 2013
Accepted January 6, 2014