Informed consent as a therapeutic intervention: tailoring expectations to maximize recovery
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".