ICU Consent

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Start of Block: Default Question Block

ICU Consent Conversations The following is a survey on housestaff training, skills, and attitudes as they relate to ICU Consent conversations. Because this conversation can

potentially involve code status discussions as well as procedural consent, questions pertain to both of these components. Please fill out the following as completely as you can. All

responses will be kept completely confidential; your name will not be associated with your answers in any way. Thank you!

I. Demographics

1. What is your sex?

o

Male (1)

o

Female (2)

2. What year of residency are you in?

o

Intern (PGY1) (1)

o

PGY 2 (2)

o

PGY 3 (3)

(2)

3. When was your most recent BIDMC MICU rotation (FICU, Orange, or Green) ? (does NOT include CCU or Brockton ICU)

o

Current (1)

o

1-3 months ago (2)

o

4-6 months ago (3)

o

More than 6 months ago (4)

o

Have not yet had an ICU rotation (5)

4. Where was your last BIDMC MICU rotation?

o

FICU (1)

o

MICU Orange (2)

o

MICU Green (3)

**Warning: there is no back button on the following page. Please ensure the above questions are accurately completed before moving on, as you will be unable to return to this page!

End of Block: Default Question Block

Start of Block: I. Informed Consent

I. INFORMED CONSENT CONVERSATIONS (GENERAL)

In this section, we ask questions about your training and experience with informed consent conversations in general (NOT specifically in the ICU) .

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1. How have you learned to have informed consent conservations (in general) with patients/families? (check all that apply)

▢

Observed peers (1)

▢

Actively taught by peers (including supervising resident) (2)

▢

Observed fellow/attending (3)

▢

Actively taught by fellow/attending (4)

▢

Formal teaching session during medical school (5)

▢

Formal teaching session during residency (6)

▢

Self-directed learning (reading, etc.) (7)

▢

None of above (8)

▢

Other (9) ________________________________________________

1a. Which one of these was most influential (please check one)?

o

Observed peers (1)

o

Actively taught by peers (2)

o

Observed fellow/attending (3)

o

Actively taught by fellow/attending (4)

o

Formal teaching session during medical school (5)

o

Formal teaching session during residency (6)

o

(4)

2. Since the beginning of your residency:

Never (1) 1-2 times (2) 3-6 times (3) More than 6 times (4) a. How many

times have you observed a resident (senior

to you) obtain informed consent for a

medical procedure? (1)

o o o o

b.How many times have you

observed a fellow or attending obtain

informed consent for a

medical procedure? (5)

o o o o

c. How many times have you

conducted an informed

consent conversation for

a medical procedure? (3)

o o o o

d. How many times have you been observed AND provided feedback about

an informed consent conversation?

(8)

o o o o

(5)

3.How important do you think informed consent conversations are for providing patient care?

o

Not important at all (1)

o

Not very important (2)

o

Moderately important (3)

o

Very important (4)

End of Block: I. Informed Consent

Start of Block: Block 6

Thank you for completing this survey! Your anonymous data may be used for research/QI purposes. If you do not wish to have your data used for research purposes, please type "Do not use my data" in the field below.

________________________________________________________________

End of Block: Block 6

Start of Block: II. ICU consent- training and experience

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II. ICU CONSENT CONVERSATIONS In the last section, we asked questions about informed consent conversations generally. In this section, we ask questions about your experience and training with regard to obtaining ICU consent specifically. ICU consent refers to the ICU "bundled" consent form, which contains a list of 11 procedures for consent.

1. How did you learn to have ICU consent conversations with patients or families? (check all that apply)

▢

Observed peers (1)

▢

Actively taught by peers (2)

▢

Observed fellow or attending (3)

▢

Actively taught by fellow or attending (4)

▢

Formal teaching session (6)

▢

None of above (8)

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2. Since the beginning of your residency:

Never (1) 1-2 times (2) 3-6 times (3) More than 6 times (4) a. How many

times have you observed a resident (senior

to you) obtain ICU consent ?

(1)

o o o o

b.How many times have you

observed a fellow or attending obtain

ICU consent ? (5)

o o o o

c. How many times have you

conducted an ICU consent conversation?

(3)

o o o o

d. How many times have you been observed AND provided feedback about an ICU consent conversation?

(8)

o o o o

(8)

3. During your ICU rotations, which team member was primarily responsible for the following tasks?

Intern (1) Resident (2) Fellow/Attending (3) Obtaining "ICU

Consent" (1)

o o o

Code Status

Discussion (2)

o o o

Goals of care

Discussion (3)

o o o

Consent for individual ICU procedures

(when needed) (4)

o o o

End of Block: II. ICU consent- training and experience Start of Block: III. ICU consent- Approach and skills

ICU CONSENT CONVERSATIONS

4. Interns and residents come to the ICU with varying levels of training and preparation to have ICU consent conversations. Please rate your skill at conducting ICU consent

conversations.

o

a. Poor (6)

o

Fair (7)

o

Good (8)

o

Very Good (9)

o

Excellent (10)

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5.Reflecting on your experience obtaining ICU consent, to what extent do you agree or disagree with the following statements?

Completely Disagree (1)

Somewhat Disagree (2)

Neither Agree nor Disagree

(3)

Somewhat Agree (4)

Completely Agree (5) a. I am

comfortable approaching

a family to discuss ICU consent. (1)

o o o o o

b. It is easy to integrate the ICU consent form into my

initial conversations

with a family member. (2)

o o o o o

c. I usually come away from the ICU

consent conversation

with a good sense of the

patient and his or her goals and values. (3)

o o o o o

d. I document what I learned about

the patient's goals and

values elsewhere in

the medical chart. (4)

o o o o o

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6. In thinking about your knowledge of the specific benefits and risks of ICU procedures, how confident are you in your ability to answer patient/family questions regarding the the following procedures? Please answer for both BENEFITS and RISKS.

BENEFITS RISKS

Not at all (1)

Only a little

(2)

Moderately (3)

Very (4)

Extremely (5)

Not at all (1)

Only a little

(2)

Moderately (3)

Very (4)

Extremely (5) a. Central

Venous Line

placement (1)

o o o o o o o o o o

b. Arterial Line

placement (2)

o o o o o o o o o o

c.

Bronchoscopy

(3)

o o o o o o o o o o

d.

Thoracentesis

(4)

o o o o o o o o o o

e. Transfusion

(6)

o o o o o o o o o o

Although you may be familiar with many potential risks of ICU procedures, for the following three questions, please think about your typical conversation reviewing the ICU bundled consent form and write only those risks that you routinely describe to patients and families during that particular conversation.

7. Please list the RISKS you typically describe for Central Venous Line placement during the ICU consent conversation:

________________________________________________________________

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________________________________________________________________

8. Please list the RISKS you typically describe for Arterial line placement during the ICU consent conversation:

________________________________________________________________

9. Please list the RISKS you typically describe for Bronchoscopy during the ICU consent conversation:

________________________________________________________________

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10. Which of the following statements best describes your approach to obtaining ICU consent?

o

I do a complete informed consent discussion for each individual procedure (1)

o

I do a complete informed consent discussion for select procedures (cross out some) (2)

o

I group procedures and discuss their general risks and benefits (vascular procedures, endoscopic procedures, etc.) (4)

o

I get a general sense of the patient/family's wishes about procedures, and describe the procedures, but give specific details (risks/benefits/alternatives) only when they have questions (3)

o

Other (5) ________________________________________________

11. For a typical new admission, how do you view the ICU consent conversation as it relates to conversations about code status and goals of care? [In this question, code status refers

specifically to preferences regarding intubation and CPR; goals of care refers to general conversation about wishes and goals for medical care].

o

I consider ICU consent as a separate "stand alone" conversation (1)

o

I usually discuss code status during the same conversation as ICU consent (2)

o

I usually discuss goals of care during the same conversation as ICU consent (3)

o

I usually discuss code status, goals of care, and ICU consent all in the same conversation (4)

End of Block: III. ICU consent- Approach and skills

Start of Block: III. ICU Consent- Attitudes

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12. To what extent do you agree or disagree with the following statements about the ICU consent form?

(5)

Somewhat Agree (6)

Completely Agree (7) a. It is

important to satisfy legal requirements.

(5)

o o o o o

b. It is important for providing the best patient

care. (6)

o o o o o

c.It facilitates my ability to establish trust

with the patient or

patient's family member. (7)

o o o o o

d. It facilitates my understanding

of the patient's goals and values as they relate to

his or her medical care.

(8)

o o o o o

e. It requires consent for

too many procedures.

(9)

o o o o o

f. It feels awkward to discuss when

I am first

meeting a

o o o o o

(14)

g. It scares or stresses

families. (11)

o o o o o

(15)

13. To what extent to you agree or disagree with the following statements?

(3)

Somewhat Agree (4)

Completely Agree (5) a. I generally

like the ICU bundled consent approach.

(10)

o o o o o

b. I feel confident that

I obtain valid informed consent for

each procedure when I obtain ICU consent.

(11)

o o o o o

c. I need more training

in how to obtain a valid

informed consent. (4)

o o o o o

d. I need more training

in the risks and benefits

of specific procedures.

(5)

o o o o o

e. I need more training

in how to obtain ICU consent. (6)

o o o o o

14. Please write any additional comments or feedback about the ICU consent process (form,

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End of Block: III. ICU Consent- Attitudes