A Survey of Current Practice of Informed Consent in Iranian Hospitals

Content Validity of the AHRQ Health Care Professional Survey on Informed Consent: A Methodological Study

Objective:

To assess the content validity of the Agency for Health Research and Quality (AHRQ) healthcare professional survey on informed consent.

Background:

The AHRQ has developed the healthcare professional survey on informed consent to assess the impact of the informed consent quality improvement training module on the healthcare professional knowledge, practices, and attitudes about informed consent.

Methods:

A qualitative study was carried out as part of a doctorate student dissertation study to assess the healthcare providers' and patients' perspectives and experiences on the informed consent process utilizing a descriptive, cross-sectional study design. The researchers have contacted 13 experts by email, asking for their voluntary support to validate the survey. The researchers adopted five domains of content validity measures, including relevancy, sufficiency, simplicity, clarity, and ambiguity. A four-point Likert scale was adopted and communicated to the experts to guide their scoring criteria. Preliminary pilot testing was done to assess the psychometric properties of the newly modified tool.

Results:

Seven experts have responded and shared their feedback either through email or hard copies, representing a response rate of 53.8%. Only one survey item scored less than 0.78 on I-CVI and was dropped from the survey. One subscale, “the Informed consent process overall effectiveness,” was dropped from the study as it falls below the acceptable level of 0.9. All edits requested by the experts' panel were done. The psychometric properties were then tested, and further enhancement of the tool was done to reach the acceptable Cronbach's alpha level.

Conclusion:

The AHRQ initiated the first stage of survey item development, and this study continued the efforts by validating the content of the survey and testing its content validity. The final poll was judged to have excellent content validity, good psychometric properties, and 41 items.

Promoting informed consent in a children's hospital in Tabriz, Iran: a best practice implementation project

INTRODUCTION

Informed consent is a continuous and dynamic process. It is a crucial part of healthcare procedures that becomes more complex in a pediatric clinical practice, where parents must make decisions for their children.

OBJECTIVES

The aim of this implementation project was to evaluate the current practice and implement the best practice related to obtaining informed consent in a children's hospital in Tabriz, Iran.

METHODS

A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (JBI PACES) tool. Five audit criteria representing the best-practice recommendations for informed consent were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to determine change in practice.

RESULTS

The compliance rate of all criteria improved from baseline to follow-up audit. Criteria 1 (obtaining informed consent prior to all nursing procedures) and 5 (provision of information related to the necessity of the treatment) reached 97% compliance in the follow-up cycle. Criterion 4 (provision of information related to the nature and effect of the treatment) achieved 74% compliance. Both criteria 2 and 3 (provision of information related to alternative treatments and consequences of refusing treatment) reached 57% in the follow-up cycle. To improve compliance, meetings were organized with the heads of departments, nurses and residents regarding informed consent. Also, staff were encouraged to report cases where informed consent was not obtained.

CONCLUSION

The audit results indicated an improvement in obtaining informed consent in the included departments. The interventions that were employed can facilitate the implementation of evidence into clinical practice.