2025/08/15 by Thomas Gower, George Clews, Samantha Black · 1 voice · 1 citation
Medicine · Health Professions · #Patient Dignity and Privacy #Ethics and Legal Issues in Pediatric Healthcare #Ethics in medical practice
paper · pdf · doi:10.1111/anae.16736
openalex publication_date 2025/08/15 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/16
The recent qualitative study by Nitzani et al. raised concerns regarding the informed consent process for women in labour [1]. The 2015 Montgomery vs. Lanarkshire Health Board case established that doctors should inform patients of all material risks during the consenting process [2], which is reflected in the latest General Medical Council guidance on decision-making and consent [3]. Nitzani et al., as well as Bogod and McCombe in the accompanying editorial [4], identified several issues in this process and concluded that the timing and quality of information provision could be improved [1, 4]. In the study by Nitzani et al., patients were mostly of high educational attainment and both this and the editorial acknowledge that issues with comprehension and consent are likely exacerbated in those with a lower health literacy. In the UK, 7.1 million adults read and write at or below the level of a 9-year-old, and 43% of adults do not understand written health information [5]. The ability of women to engage in the consent process is also affected by the pain of labour as well as the effect of other analgesics used to treat this pain [1, 4]. The Royal College of Anaesthetists (RCoA) is at the forefront of creating risk infographics to aid consent discussions, which are researched and user tested with patient groups. Two infographics have been created in conjunction with the Obstetric Anaesthetists' Association and the Winton Centre for Risk and Evidence Communication at the University of Cambridge regarding the provision of epidural and spinal anaesthesia in obstetrics. This follows on from the success of patient infographics for both adult and paediatric general anaesthesia, which are some of the most downloaded resources from the RCoA. The new patient infographics focus on presenting risk using simple, unambiguous language and numerical risk displayed in a way that patients understand, alongside graphical representations. We have included a sample of the epidural resource (online Supporting Information Figure S1). Patients from a wide variety of backgrounds were involved in the research and co-design of these infographics to ensure their relevance. We conducted user testing at our local hospital among obstetric patients due to have either an epidural or spinal anaesthetic. Fourteen patients in total were surveyed, after being given the infographics during their time in the delivery suite. All of them understood the information and risks about epidural and spinal anaesthesia either ‘very’ or ‘somewhat well’ and felt more confident about discussing anaesthetic options with a healthcare professional. Nine of patients felt ‘reassured’ after reading the infographics, and five felt ‘concerned but informed’. Importantly, all patients found the language, images and icons used appropriate for their cultural or personal background, a reflection of the attempts of the team to make this resource accessible for all educational levels and cultural backgrounds. Qualitative feedback from patients included that the infographics should be given out antenatally. This was reflected in the professional feedback, as all 11 midwives and anaesthetists surveyed felt that information should be given out antenatally. Of the midwives, four of six also felt that their patients rarely had access to online/written resources to help them make informed decisions regarding spinal/epidural anaesthesia. We believe that the introduction of infographics for epidural and spinal anaesthesia in obstetrics will help address the identified need for high-quality and widely accessible information that can be provided to the obstetric population antenatally. The next important step is to engage midwives, anaesthetists and patients on the best time to provide this information during pregnancy to have the most impactful effect. This will allow patients to make more informed choices about what is right for them during a time with significant physiological and psychological demands. Figure S1. Patient infographics describing the risks and adverse effects of epidural analgesia. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.