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Liam Rose, PhD
Liam Rose is a health economist and investigator with the Health Economics Resource Center at VA Palo Alto. His research focuses on applied microeconomics with an emphasis on econometric techniques that can provide causal inference. His work focuses on access to care, utilization, and changes in health in the transitions to Medicare and retirement. Liam has a PhD in Economics from the University of California, Santa Cruz.
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Sabine Girod, MD DDS PhD FACS
Professor Sabine Girod is the Chief of the Oral Medicine & Maxillofacial Surgery Service at Stanford University, USA. She trained in Cranio-Maxillofacial Surgery in Germany and completed a postdoctoral research fellowship at the Dana-Farber Cancer Institute (Harvard Medical School) in Boston. In 2000 she joined the faculty of Stanford University and is now Professor of Surgery and Otolaryngology (by courtesy). Her special clinical and research interests are Maxillofacial Surgery and Computer Aided Surgery.
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Linda Diem Tran
POSTDOCTORAL RESEARCH FELLOW, S-SPIRE CENTER
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Diem Tran holds a master's degree in Public Policy and a PhD in Health Policy and Management from UCLA. Her research centers on the social production of health inequities and disparities in health care stemming from public policies and inefficiencies in delivery systems. Diem is currently a postdoctoral fellow with the Department of Veterans Affairs and Stanford University.
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Lost in translation: Informed consent in the medical mission setting.
Surgery
Sceats, L. A., Morris, A. M., Narayan, R. R., Mezynski, A., Woo, R. K., Yang, G. P.
2018
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Abstract
BACKGROUND: Informed consent is a fundamental tenet of ethical care, but even under favorable conditions, patient comprehension of consent conversations may be limited. Little is known about providing informed consent in more uncertain situations such as medical missions. We sought to examine the informed consent process in the medical mission setting.METHODS: We studied informed consent for adult patients undergoing inguinal herniorrhaphy during a medical mission to Guatemala using a convergent mixed-methods design. We audiotaped informed consents during preoperative visits and immediately conducted separate surveys to elicit comprehension of risks. Informed consent conversations and survey responses were translated and transcribed. We used descriptive statistics to examine informed consent content, including information provided by surgeon, the translation of information, and patient comprehension, and used thematic analysis to examine the consent process.RESULTS: Thirteen adult patients (median age 53 years, 69% male) participated. Surgeons conveyed 4 standard risks in 10 out of 13 encounters (77%); all 4 risks were translated to patients in 10 out of 13 encounters (77%). No patient could recall all 4 risks. Qualitative themes regarding the informed consent process included limited physician language skills, verbal domination by physicians and interpreters, and mistranslation of risks. Patients relied on faith and prior or vicarious experiences to qualify surgical risks instead of consent conversations. Many patients restated surgical instructions when asked about risks.CONCLUSION: Despite physicians' attempts to provide informed consent, medical mission patients did not comprehend surgical risks. Our data reveal a critical need to develop more effective methods for communicating surgical risks during medical missions.
View details for PubMedID 30061041