Informed consent as a therapeutic intervention: tailoring expectations to maximize recovery
Notice bibliographique
Résumé
Informed consent is an integral component of modern medicine; however, gaps between ethical objectives and psychological corollaries linger. Despite mounting evidence to demonstrate its impact on human behavior, physicians and bioethicists scantily construe it as a source of therapeutic influence. Here we explore judicious ways to leverage this standard-of-care tool as both an ethical requisite in the clinical milieu and a procedure, which could either bolster or deflate the health of individuals, perhaps through a placebo effect.First, in a literature review, we examine the history and components of the informed consent process, and its relation to bioethical principles and patient-practitioner models. We explore relevant psychological mechanisms, such as the placebo and nocebo effect, that are inherent in consent discussions as well as in clinical practice. Applying this information, we offer an attractive recommendation that not only harmonizes the sometimes-clashing bioethical principles of autonomy and non-malfeasance, but also serves as an intervention to improve therapeutic outcome. Further, the review explains the ethical concerns embedded in placebo use, such as deception, abuse of trust, and manipulation, and shows how using the informed consent to elicit a placebo effect withstands ethical scrutiny.Second, we investigate if the informed consent process may actually function as a therapeutic, autonomous intervention. We tested if suggestions given during the informed consent procedure could elicit a placebo effect that would influence the postoperative experience of patients undergoing third molar extractions. Results from this randomized controlled pilot study at the Jewish General Hospital in Montreal indicated that slightly modifying consent form information and tenor decreased overall symptom severity scores on the Postoperative Symptom Severity Scale for experimental subjects compared to controls, as well as overall pain scores on the McGill Pain Questionnaire. Our findings suggest that altering expectations during the informed consent discussion may minimize manifested symptoms experienced post-surgically.Lastly, we study the risk factors often considered to influence postoperative recovery following third molar extractions. The analysis included patients' preoperative expectations as a determinant for the severity of postsurgical pain. Standardized coefficients demonstrated that out of age, gender, number of teeth removed, difficulty of extraction, operation time, intervention, and patient expectations, the latter was the largest significant predictor of postoperative pain scores. These results demonstrate that preoperative expectations are of utmost importance when predicting and determining the severity of patient recovery.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».