Misdirections in Informed Consent — Impediments to Health Care Innovation

Abstract

To increase colorectal cancer screening rates, ABC Health System decides to send birthday cards to patients when they turn 50. The cards read, “It’s your 50th birthday — treat yourself to a colonoscopy!” and contain coupons for free Gatorade and MiraLAX and a book of crossword puzzles to keep the recipient occupied while on the toilet. ABC’s idea is that some whimsy might help overcome colonoscopy’s “ickiness” barrier. XYZ Health System has the same goal. The birthday cards they send include notification of a prescheduled colonoscopy appointment, with options for selecting a more convenient time. Their idea is to frame screening as the default. Both ABC and XYZ health systems plan evaluations with pre–post designs to assess whether screening rates change. No one objects, since the approaches are well-meaning, plausible, safe, and consistent with clinical guidelines.