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Study protocol for a randomised controlled trial of consenting processes and their effects on patient decision-making when undergoing spinal injections: the Risks In Spinal Consenting for Surgery (RISCS) trial
  1. James W A Fletcher1,2,
  2. Mohsin Khan2,3,
  3. Paul L P J Thorpe4
  1. 1 Department for Health, University of Bath, Bath, UK
  2. 2 Severn School of Surgery, Health Education England, Bristol, UK
  3. 3 Department of Trauma and Orthopaedics, Bristol Royal Hospital for Children, Bristol, UK
  4. 4 Somerset Spinal Surgery Service, Musgrove Park Hospital Taunton and Somerset NHS Foundation Trust, Taunton, UK
  1. Correspondence to Mr James W A Fletcher; jwa.fletcher{at}


Introduction There are major differences between legal and medical approaches to informed consent. Medically, consent is obtained prospectively for an intended procedure, to inform the patient of choices, risks and benefits, and to manage expectations. Legally, consent is reviewed retrospectively, usually following unmet expectations and/or the occurrence of complications. Recent legal cases relating to clinical negligence define the establishment of causation and breach of duty related to informed consent. However, there is no prospective evidence to validate the current judicial perspectives on causation and thus clinical negligence. The aim of this randomised controlled trial (RCT) is to investigate whether variations in consenting processes for the same procedure lead to changes in patient decision-making related to consent for that procedure.

Methods and analysis The Risks In Spinal Consenting for Surgery trial is a single-centre, non-inferiority RCT, where 220 patients, aged over 18 years, receiving an elective, day case spinal injection, will be randomised to either a ‘legally styled’ consent form with 55 risks identified in the world literature, or a ‘medically styled’ consent form with the 13 serious or most common risks usually quoted by reference to specialist society guidelines. Following explanation of the medical reasons for considering an injection therapy and consent to the trial, participants will be randomly allocated to one of two groups (1:1). The patients are then given the opportunity to discuss any concerns relating to the procedure and/or risks with a single specialist practitioner. The primary outcome will be rates of consent withdrawal due to the risks explained. Secondary outcomes include scores from the State-Trait Anxiety Inventory, Visual Analogue Scale, EuroQol 5-dimension questionnaire and Oswestry Disability Index.

Ethics and dissemination Results will be presented in peer-reviewed journals and at international conferences. This study is approved by the Health Research Authority: REC 16/SC/0510.

Trial registration number ISRCTN67513618; Pre-results.

  • medical law
  • medical ethics
  • surgery
  • clinical trials

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  • Contributors JWAF, MK and PT wrote the protocol and designed the study; all authors critically reviewed the manuscript.

  • Funding This study was supported by the Bristol Orthopaedic Trust and the Henry Bissell Spinal Fund.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study is approved by the Health Research Authority: REC 16/SC/0510 and will be conducted in agreement with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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