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Basukala S, Shrestha O, Thapa N, Karki S, Pandit A, Thapa BB, Thapa A. How informed is informed consent?-Evaluating the quality of informed consent among surgical patients in a tertiary care hospital in Nepal. PLoS One 2023; 18:e0288074. [PMID: 37428760 DOI: 10.1371/journal.pone.0288074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Informed consent-taking is a part of clinical practice that has ethical and legal aspects attached to it. This protects the autonomy of the patients by providing complete information regarding the rationale, modality, potential risks, benefits, and alternatives of the planned procedure to the patients. This enables the patients to make the right decision for themselves and their care. This study aims to find out if the informed consent-taking process has ensured the active participation of the patients or the next of kin in the decision-making. MATERIALS AND METHODS This is a prospective cross-sectional study conducted in a military healthcare institution among patients undergoing major surgical procedures from July 2022 to October 2022. Ethical clearance was obtained before the commencement of this study. A structured questionnaire was prepared, and the collected data was refined in Excel and imported into SPSS for analysis. RESULTS A total of 350 individuals of mean age 47.95 ± 16.057 years were part of this study. The majority of the respondents were married, literate, and family by beneficiary category. All of the respondents received and signed the consent form. About 77% of the respondents read it completely, and 95.4% of them reported that it was understandable. The majority of the patients did not know who was going to perform the surgery, the alternatives to the planned treatment, the benefits of the surgery, or the outcome of non-treatment. On the patient satisfaction scale, 16.28% of the participants agreed that they were satisfied with the informed consent-taking process. CONCLUSION Deficiencies in the informed consent-taking process were the lack of dissemination of adequate information on the nature, duration, pros and cons, post-operative state, and alternative of the planned procedure. A well-structured format of the consent form that is specific to a particular procedure should be adopted, and various alternatives to it must be disseminated to the patient or the next of kin to improve the quality of the informed consent-taking process.
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Affiliation(s)
- Sunil Basukala
- Department of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Oshan Shrestha
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Niranjan Thapa
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Sagun Karki
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Ayushma Pandit
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Bikash Bikram Thapa
- Department of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Anup Thapa
- Department of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Mitra K, Mondal S, Bhattacharya S, Jana P. A comparative study on comprehension of informed consent before emergency and elective surgical operative procedures. ACTA MEDICA INTERNATIONAL 2022. [DOI: 10.4103/amit.amit_90_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Glaser J, Nouri S, Fernandez A, Sudore RL, Schillinger D, Klein-Fedyshin M, Schenker Y. Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review. Med Decis Making 2020; 40:119-143. [PMID: 31948345 DOI: 10.1177/0272989x19896348] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background. Patient comprehension is fundamental to valid informed consent. Current practices often result in inadequate patient comprehension. Purpose. An updated review to evaluate the characteristics and outcomes of interventions to improve patient comprehension in clinical informed consent. Data Sources. Systematic searches of MEDLINE and EMBASE (2008-2018). Study Selection. We included randomized and nonrandomized controlled trials evaluating interventions to improve patient comprehension in clinical informed consent. Data Extraction. Reviewers independently abstracted data using a standardized form, comparing all results and resolving disagreements by consensus. Data Synthesis. Fifty-two studies of 60 interventions met inclusion criteria. Compared with standard informed consent, a statistically significant improvement in patient comprehension was seen with 43% (6/14) of written interventions, 56% (15/27) of audiovisual interventions, 67% (2/3) of multicomponent interventions, 85% (11/13) of interactive digital interventions, and 100% (3/3) of verbal discussion with test/feedback or teach-back interventions. Eighty-five percent of studies (44/52) evaluated patients' understanding of risks, 69% (41/52) general knowledge about the procedure, 35% (18/52) understanding of benefits, and 31% (16/52) understanding of alternatives. Participants' education level was reported heterogeneously, and only 8% (4/52) of studies examined effects according to health literacy. Most studies (79%, 41/52) did not specify participants' race/ethnicity. Limitations. Variation in interventions and outcome measures precluded conduct of a meta-analysis or calculation of mean effect size. Control group processes were variable and inconsistently characterized. Nearly half of studies (44%, 23/52) had a high risk of bias for the patient comprehension outcome. Conclusions. Interventions to improve patient comprehension in informed consent are heterogeneous. Interactive interventions, particularly with test/feedback or teach-back components, appear superior. Future research should emphasize all key elements of informed consent and explore effects among vulnerable populations.
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Affiliation(s)
- Johanna Glaser
- School of Medicine, University of California, San Francisco, CA, USA
| | - Sarah Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Alicia Fernandez
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Dean Schillinger
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | | | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Zeeshan MF, Yousufi Z, Khan D, Malik FR, Ashfaq F, Batool F, Atta L, Tariq H, Huma Z, Ghafoor R, Jamil A, Qazi U. Informed consent practice for obstetric and gynaecologic procedures: A patients' perspective from a developing country. J Eval Clin Pract 2019; 25:491-497. [PMID: 30815974 DOI: 10.1111/jep.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess the surgical informed consent (SIC) practices for obstetric and gynaecological (OB-GYN) procedures at different hospitals in Pakistan. METHODS Study was conducted in five hospitals (three public and two private) of Peshawar, Pakistan. A pretested structured tablet-based questionnaire was administered from October 2016 through January 2017 among post-op OB-GYN patients. RESULTS About 27% of the patients (significantly more in private hospitals, P = 0.001) did not remember a formal consent administration. Most patients (80%) felt they had no choice about signing the consent. About 65% (mostly in public as compared with private hospitals) mentioned that they would have signed it regardless of the specifics in it (P < 0.001). Patients had increased odds to recall consent if they felt empowered, odds ratio (OR) = 4.5; had an opportunity to ask questions, OR = 7.2; wanted more explanation, OR = 2.8; and had consent administered in their mother tongue, OR = 6.9. DISCUSSION Patients' recall of key elements of consent was low. The time spent with the patient for consenting was much shorter than recommended. The printed consent forms were mostly not available in patients' mother tongue. CONCLUSIONS Consent practice for OB-GYN procedures was suboptimal in studied hospitals. Patients' attitude toward informed consent practices largely reflected providers' focus on obtaining a legally valid signed consent as opposed to administering a consent that empowers patients to make an informed decision in the absence of any external pressure.
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Affiliation(s)
- Muhammad F Zeeshan
- Prime Institute of Public Health, Riphah International University, Islamabad, Pakistan.,Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Zainab Yousufi
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Durdana Khan
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Farhat R Malik
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Fizza Ashfaq
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Fatima Batool
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Lyaba Atta
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Hira Tariq
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Zille Huma
- Department of Health, Khyber Pakhtunkhwa, Pakistan
| | - Rahat Ghafoor
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Ayisha Jamil
- Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Umair Qazi
- Prime Institute of Public Health, Riphah International University, Islamabad, Pakistan
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Shoemaker SJ, Brach C, Edwards A, Chitavi SO, Thomas R, Wasserman M. Opportunities to Improve Informed Consent with AHRQ Training Modules. Jt Comm J Qual Patient Saf 2018; 44:343-352. [PMID: 29793885 DOI: 10.1016/j.jcjq.2017.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Informed consent is a process of communication between clinician and patient that results in the patient's decision about whether to undergo a specific intervention. However, patients often do not understand the risks, benefits, and alternatives, even after signing a consent form. METHODS Mixed-methods pilot test of two Agency for Healthcare Research and Quality (AHRQ) informed consent training modules implemented in four hospitals. Methods included staff and patient surveys, interviews, site visits, and pre- and posttests of the modules. RESULTS A low proportion of clinicians reported using teach-back (40.0%) or high-quality decision aids (55.0%). Patients reported limited use of best practices, including being asked to teach-back (58.4%), having other options described (54.9%), viewing decision aids (37.4%), and finding the form very easy to understand (66.8%). Content of the training modules aligned well with identified deficiencies. Barriers to completing the modules included staff turnover, competing demands, and lack of accountability. Facilitators included committed champions with available time, motivation, and release time for staff to take modules. Knowledge increased for leaders (p <0.05) and staff (p <0.001) who completed the training modules. Hospitals reported the effects of piloting the modules included fostering dialogue and identifying opportunities for improvements, identifying and rectifying policy ambiguity and noncompliance, reinforcing the use of interpreter services, and using modules' strategies and tools to improve informed consent. CONCLUSION Many opportunities exist for hospitals to improve their informed consent practices. AHRQ's two training modules, have face validity, addressed demonstrated deficiencies in hospitals' informed consent policies and processes, and stimulated improvement activity in motivated hospitals.
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Chou FY, Kuang LY, Lee J, Yoo GJ, Fung LC. Challenges in Cancer Self-management of Patients with Limited English Proficiency. Asia Pac J Oncol Nurs 2016; 3:259-265. [PMID: 27981169 PMCID: PMC5123524 DOI: 10.4103/2347-5625.189815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: This paper summarizes the barriers and challenges in cancer care reported from a validation project of a self-management intervention handbook from Chinese-American cancer patients with limited English proficiency (LEP). Methods: Seven health-care providers (HCPs) and 16 Chinese-American cancer survivors with LEP were invited to validate a self-management intervention handbook through networking sampling method. Bilingual versions were developed and validated using the repeated translation process. Online and paper-based survey and interview were conducted to collect information on the perception of barriers and experiences on cancer care. Data were analyzed by the content analysis method. Results: The HCPs reported a bilingual self-management handbook which is useful and feasible for patient self-management. The challenges in giving cancer care to LEP patients included: patients do not engage in discussion, different cultural health beliefs, unable to speak to patients in their primary language, and patients are less likely to discuss emotional and social challenges during treatments. The common barriers and experiences during cancer care included: limited understanding about treatment/medication and side effects, language barriers such as unable to communicate to make the decision, unable to understand information related to resources and do not know what questions to ask, and do not know what to expect during their cancer treatment. Conclusions: The current findings highlight the need of cancer self-management support for culturally diverse LEP cancer patients. Further research can include applying the supportive intervention to all LEP cancer patients.
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Affiliation(s)
- Fang-Yu Chou
- School of Nursing, San Francisco State University, San Francisco, CA, USA
| | - Lily Y Kuang
- Department of Nursing, Chinese Hospital, San Francisco, CA, USA
| | - Jeannette Lee
- Physical Therapy, San Francisco State University, San Francisco, CA, USA
| | - Grace J Yoo
- Asian American Studies, San Francisco State University, San Francisco, CA, USA
| | - Lei-Chun Fung
- Health Education, Chinatown Public Health Center, San Francisco, CA, USA
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