1
|
Oravec N, Arora RC, Bjorklund B, Gregora A, Monnin C, Dave MG, Duhamel TA, Kent DE, Schultz ASH, Chudyk AM. Patient and caregiver preferences and prioritized outcomes for cardiac surgery: A scoping review and consultation workshop. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01675-5. [PMID: 34924192 DOI: 10.1016/j.jtcvs.2021.11.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE(S) In light of the absence of patient and caregiver input in Enhanced Recovery After Surgery Cardiac Surgery guideline development, we conducted a scoping review to identify patient and caregiver preferences and prioritized outcomes related to perioperative care in cardiac surgery and its lifelong impact. METHODS Five electronic databases were searched to retrieve studies investigating patient or caregiver preferences and prioritized outcomes. Information was charted in duplicate and analyzed using descriptive statistics or thematic analysis. A patient and caregiver consultation workshop validated scoping review findings and solicited novel preferences and outcomes. RESULTS Of the 5292 articles retrieved, 43 met inclusion criteria. Most were from Europe (n = 19, 44%) or North America (n = 15, 35%) and qualitative and quantitative designs were represented in equal proportions. Fifty-two methods were used to obtain stakeholder preferences and prioritized outcomes, the majority being qualitative in nature (n = 32, 61%). Based on the collective preferences of 3772 patients and caregivers from the review and 17 from the consultation workshop, a total of 108 patient preferences, 32 caregiver preferences, and 19 prioritized outcomes were identified. The most commonly identified theme was "information and education." Improved quality of life was the most common patient-prioritized outcome, and all caregiver-prioritized outcomes were derived from the consultation workshop. CONCLUSIONS Patient and caregiver preferences overlap with Enhanced Recovery After Surgery Cardiac Surgery recommendations targeting preoperative risk reduction strategies, prehabilitation, patient engagement technology, and intra- and postoperative strategies to reduce discomfort. To support clinical practice, future research should investigate associations with key surgical outcomes.
Collapse
Affiliation(s)
- Nebojša Oravec
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Cardiac Sciences, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Brian Bjorklund
- Enhanced Recovery Protocols for Cardiac Surgery Patient Researcher Group, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - April Gregora
- Enhanced Recovery Protocols for Cardiac Surgery Patient Researcher Group, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Caroline Monnin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mudra G Dave
- Department of Cardiac Sciences, St Boniface General Hospital, Winnipeg, Manitoba, Canada; Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, St Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - David E Kent
- Department of Cardiac Sciences, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Annette S H Schultz
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada; Health Services & Structural Determinants of Health Research Group, St Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Anna M Chudyk
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada; Health Services & Structural Determinants of Health Research Group, St Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada.
| |
Collapse
|
2
|
Vohra HA, Salmasi MY, Chien L, Baghai M, Deshpande R, Akowuah E, Ahmed I, Tolan M, Bahrami T, Hunter S, Zacharias J. BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting. Open Heart 2020; 7:openhrt-2020-001259. [PMID: 33020254 PMCID: PMC7537434 DOI: 10.1136/openhrt-2020-001259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/26/2020] [Accepted: 08/25/2020] [Indexed: 02/03/2023] Open
Abstract
Disseminating the practice of minimally invasive mitral surgery (mini-MVS) can be challenging, despite its original case reports a few decades ago. The penetration of this technology into clinical practice has been limited to centres of excellence, and mitral surgery in most general cardiothoracic centres remains to be conducted via sternotomy access as a first line. The process for the uptake of mini-MVS requires clearer guidance and standardisation for the processes involved in its implementation. In this statement, a consensus agreement is outlined that describes the benefits of mini-MVS, including reduced postoperative bleeding, reduced wound infection, enhanced recovery and patient satisfaction. Technical considerations require specific attention and can be introduced through simulation and/or use in conventional cases. Either endoballoon or aortic cross clamping is recommended, as well as femoral or central aortic cannulation, with the use of appropriate adjuncts and instruments. A coordinated team-based approach that encourages ownership of the programme by the team members is critical. A designated proctor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases, is an important step to consider. The importance of pre-empting complications and dealing with adverse events is described, including re-exploration, conversion to sternotomy, unilateral pulmonary oedema and phrenic nerve injury. Accounting for both institutional and team considerations can effectively facilitate the introduction of a mini-MVS service. This involves simulation, team-based training, visits to specialist centres and involvement of a designated proctor to oversee the initial cases.
Collapse
Affiliation(s)
- Hunaid A Vohra
- Cardiac Surgery, Bristol Heart Institute, Bristol, Bristol, UK
| | - M Yousuf Salmasi
- Surgery and Cancer, Imperial College London, London, United Kingdom, UK
| | - Lueh Chien
- Faculty of Medicine, Imperial College London, London, London, UK
| | - Max Baghai
- Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, London, UK
| | | | - Enoch Akowuah
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Ishtiaq Ahmed
- Cardiac Surgery, Brighton and Sussex NHS LKS Royal Sussex County Hospital, Brighton, Brighton and Hove, UK
| | | | - Toufan Bahrami
- Cardiac Surgery, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Steven Hunter
- Cardaic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK
| | - Joseph Zacharias
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | | |
Collapse
|
3
|
Villanueva C, Talwar A, Doyle M. Improving informed consent in cardiac surgery by enhancing preoperative education. PATIENT EDUCATION AND COUNSELING 2018; 101:2047-2053. [PMID: 29937111 DOI: 10.1016/j.pec.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the effect of enhancing preoperative education in improving recall and understanding of a surgical procedure and its application to the informed consent process in cardiac surgery. METHODS Four electronic database searches were performed from January 2000 to August 2017. A total of 282 articles were identified from which 22 prospective studies assessing an intervention were selected according to predefined selection criteria. RESULTS Most articles that used additional written information and all that used multimedia presentations to enhance informed consent showed that their intervention improved risk recall and patient's understanding of the procedure. A single randomised controlled trial in cardiac surgery showed that audiotaped consultations improved patient's knowledge of the operation. CONCLUSIONS Patient recall and understanding of pre-operative information can significantly improve with a variety of educational tools. Procedure-specific forms with or without illustrations as well as interactive multimedia interventions enhance patient recall and understanding of information. In cardiac surgery patients, interventions need to meet patients' preferences, be repetitive on crucial points and consider the nature of the procedure.
Collapse
Affiliation(s)
- Claudia Villanueva
- Cardiothoracic Surgery Unit, Royal North Shore Hospital, Sydney, Australia; Conjoint Lecturer University of New South Wales, Sydney, Australia.
| | - Arpit Talwar
- Cardiothoracic Surgery Unit, Royal North Shore Hospital, Sydney, Australia
| | - Mathew Doyle
- Cardiothoracic Surgery Unit, St George Hospital, Sydney, Australia
| |
Collapse
|
4
|
Vaezi A, Sepehri nia M, Shali M. Assessing the quality of receiving patients’ informed consent in the surgical wards of hospitals affiliated to Zanjan University of Medical Sciences. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2018. [DOI: 10.29252/pcnm.8.3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
5
|
Helder MRK, Schaff HV, Hanson KT, Thiels CA, Dearani JA, Daly RC, Maltais S, Habermann EB. Patient Experience After Cardiac Surgery: Identifying Areas for Improvement. Ann Thorac Surg 2018; 107:780-786. [PMID: 30414830 DOI: 10.1016/j.athoracsur.2018.09.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 08/29/2018] [Accepted: 09/17/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a publicly reported survey of patient experience with in-hospital care. We reviewed institutional HCAHPS survey data to assess our patients' experiences after cardiac surgery and to identify targets for practice improvement. METHODS We reviewed data from patients undergoing the most common cardiac operations, with dismissal from October 1, 2012 to September 30, 2015. We used top-box methodology to combine survey results into nine domains, including the global (composite) hospital rating, dichotomized as high versus low. Multivariable logistic regression analysis was used to evaluate the independent associations of variables with low global ratings. Key driver analysis using domain means and Spearman correlation between the global rating and the eight other domains identified targets for quality improvement. RESULTS Among 1,315 surveyed patients a low global hospital rating was independently associated with low perceived overall health (fair or poor vs excellent; odds ratio [OR], 5.4; p = 0.001), younger age (18 to 59 vs ≥70 years; OR, 1.6; p = 0.048), prolonged length of stay (OR, 1.6; p = 0.02), and robotic mitral valve (MV) repair (robotic vs open repair; OR, 2.4; p = 0.045). Patients undergoing transcatheter aortic valve replacement (TAVR) reported global ratings similar to that of patients with open aortic valve operations (OR, 0.9; p = 0.64). Key drivers of patient experience were care transitions and communication regarding medications. CONCLUSIONS The primary targets of improvement for our institution are care transitions and communications regarding medications. The less-invasive procedures (robotic MV repair, TAVR) were not independently associated with higher patient-experience scores.
Collapse
Affiliation(s)
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kristine T Hanson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Cornelius A Thiels
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Simon Maltais
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
6
|
Zener R, Johnson P, Wiseman D, Pandey S, Mujoomdar A. Informed Consent for Radiation in Interventional Radiology Procedures. Can Assoc Radiol J 2018; 69:30-37. [DOI: 10.1016/j.carj.2017.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/05/2017] [Accepted: 07/19/2017] [Indexed: 11/15/2022] Open
Abstract
Purpose To explore the patient perception on radiation-related cancer risk from interventional radiology (IR) procedures and whether informed radiation consent is warranted. Methods A multiple-choice survey was prospectively administered to 68 adults undergoing a body or neuro-IR procedure with ionizing radiation exposure. Subgroup analysis with chi-square or Fisher exact test was performed based on patient past IR history ( P < .05). Results A total of 81% of patients wanted to be informed if there was a radiation-related 3% increased cancer risk over 5 years. Although 55% considered 3% a small risk, 28% wanted to further discuss the risks and alternate options, and 15% would have only proceeded if it were a life-saving procedure: 89%, 80%, and 67% of patients wanted to be informed with exposure risks of 1 in 100, 1 in 1000, and 1 in 10,000, respectively. Only 53% were aware they were going to be exposed to radiation, irrespective of past IR history ( P = .15). Most patients believed radiation consent should include radiation-related cancer risks (85%). No past IR history was significantly associated with wanting consent to include cancer-related risk (100% vs 76%; P = .01) and deterministic risks (70% vs 41%; P = .04). A majority (69%) believed both the referring physician and the interventional radiologist were responsible for obtaining radiation consent, and 65% of patients wanted verbal consent followed by signed written consent, regardless of past IR history. Conclusions Many patients want to discuss cancer-related radiation risks with both radiologists and physicians. Informed radiation consent should be considered for procedures with high anticipated radiation doses.
Collapse
Affiliation(s)
- Rebecca Zener
- Victoria Hospital, London Health Sciences Centre, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Peter Johnson
- University Hospital, London Health Sciences Centre, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Daniele Wiseman
- Victoria Hospital, London Health Sciences Centre, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Sachin Pandey
- University Hospital, London Health Sciences Centre, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Amol Mujoomdar
- Victoria Hospital, London Health Sciences Centre, Department of Medical Imaging, Western University, London, Ontario, Canada
| |
Collapse
|
7
|
Gainer RA, Curran J, Buth KJ, David JG, Légaré JF, Hirsch GM. Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives. Med Decis Making 2016; 37:600-610. [PMID: 27803362 DOI: 10.1177/0272989x16675338] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. METHODS Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. RESULTS We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. CONCLUSIONS Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention early in the decision process, the use of individualized decision aids that employ graphic risk presentations, and a dedicated decisional coach were identified by patients and providers as approaches with a high potential for success. The impact of such a formalized shared decision making process in cardiac surgery on decisional quality will need to be formally assessed. Given the trend toward older and frail patients referred for complex cardiac procedures, the need for an effective shared decision making process is compelling.
Collapse
Affiliation(s)
- Ryan A Gainer
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| | - Janet Curran
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| | - Karen J Buth
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| | - Jennie G David
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| | - Jean-Francois Légaré
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| | - Gregory M Hirsch
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| |
Collapse
|
8
|
Joolaee S, Faghanipour S, Hajibabaee F. The quality of obtaining surgical informed consent. Nurs Ethics 2015; 24:167-176. [DOI: 10.1177/0969733015584398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Informed consent goes beyond signing a form; it is a process of providing necessary information, helping patients make an informed decision, and actively participate in their treatment. Aim/objective: This study aimed to assess the quality of obtaining surgical informed consent in hospitals affiliated with Tehran University of Medical Sciences. Research design/participants/context: In a cross-sectional, descriptive-analytical study, 300 patients were chosen through stratified sampling from seven hospitals affiliated with Tehran University of Medical Sciences. Data were collected using a questionnaire developed by the researchers and analyzed using descriptive and analytical statistics on SPSS software. Ethical considerations: Ethical approval of this study was granted by Tehran University of Medical Sciences research ethics committee. Written informed consent for participation was obtained. The participants were reassured that their information will be used anonymously and their answers will not affect their treatment and care. Findings: The mean score of quality of acquisition of informed consent was 17.13 out of 35, indicating that the quality falls in the inappropriate category. The results indicate that 48% of the signatories do not even read the form before signing it. Among the 52% who did read the consent form, 61.3% mentioned varying degrees of incomprehensibility of the consent form and 94.2% mentioned the presence of incomprehensible technical, medical and legal vocabulary. Only 12% and 18% of respondents reported that they were not in hurry and they had no fear or anxiety, respectively, when signing the form. The quality of obtaining informed consent was higher in women, younger patients, patients with higher education, and those who had special surgeries. Discussion: This study shows a poor practice in obtaining surgical informed consent in Iran. It seems necessary to consider fundamental changes in the process of acquiring consent based on the temporal and local conditions of the patients.
Collapse
Affiliation(s)
- Soodabeh Joolaee
- Iran University of Medical Sciences, Iran; University of British Colombia, Canada
| | | | | |
Collapse
|
9
|
Kim S, Jabori S, O'Connell J, Freeman S, Fung CC, Ekram S, Unawame A, Van Norman G. Research methodologies in informed consent studies involving surgical and invasive procedures: time to re-examine? PATIENT EDUCATION AND COUNSELING 2013; 93:559-566. [PMID: 24021416 DOI: 10.1016/j.pec.2013.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/20/2013] [Accepted: 08/13/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE We conducted a review of informed consent studies involving surgical and invasive procedures and report the degree to which current research targets a broader scope of patient outcomes beyond comprehension. METHODS Using PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medical Database, we identified 97 articles for review. Six members coded articles and generated scores of study design quality. RESULTS The mean quality score (10.7 out of a total score of 20) was low. Most studies were single institution-based, relying on one-time data collections. Randomly assigning subjects to study conditions, using power analysis to determine subject numbers, and reporting psychometric evidence, such as reliability and validity, were not widely reported. Most frequently targeted patient outcomes were knowledge, understanding and satisfaction. Core informed consent outcomes (e.g. capacity, voluntariness, decision making) and emotional factors (e.g. anxiety) were not extensively addressed. CONCLUSION Informed consent research may benefit from applying qualitative methods to more directly tap into patients' beliefs and decisions by eliciting in patients' own words their emotions and reasoning around processing informed consent content. PRACTICE IMPLICATIONS Research that addresses patient perspectives toward surgical interventions should tap into underexplored ethical and emotional factors that shape decision making.
Collapse
Affiliation(s)
- Sara Kim
- ISIS (Institute of Simulation and Interprofessional Studies), Department of Surgery, School of Medicine, University of Washington, Seattle, USA.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Faghanipour S, Joolaee S, Sobhani M. Surgical informed consent in Iran—how much is it informed? Nurs Ethics 2013; 21:314-22. [DOI: 10.1177/0969733013498525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Informed consent constitutes one of the most important legal, professional, and ethical principles of a surgical operation. Consent obtained from a patient is only valid when the patient has received enough information regarding the proposed treatment option. This study aims to determine how much the patients are informed before undergoing surgery, as well as the factors influencing it in hospitals affiliated with Tehran University of Medical Sciences. Method: This is a cross-sectional, descriptive–analytic study of 300 patients undergoing surgery in 7 teaching hospitals affiliated with Tehran University of Medical Sciences. The patients were recruited through clustered sampling. Data were collected using a questionnaire completed by interview. Data were analyzed on SPSS software using descriptive and inferential statistics. Result: The mean score of data provision for patients was 27.09 out of 60, indicating the level of information provided as unacceptable. Among 12 questions dealing with data provision, patients had received an intermediate level of information about nature of the disease, type of surgery, benefits and importance of the surgery, and complications of rejecting the recommended therapy. On the contrary, they had not received enough information about the surgical procedure, type of anesthesia, potential complications of surgery, potential risks of surgery, other therapy options instead of surgery, length of hospital stay for surgery, postsurgical follow-up, and expenses of the surgery. In the majority (85%) of cases, the surgeon was reported to be the information provider. Among the variables studied, level of information received was directly related to the patient’s education level. Discussion: The findings of this study indicate that during the process of obtaining an informed consent for surgery, patients do not receive sufficient information, and it is necessary to provide the essential information in an understandable manner adjusted for the patient’s level of education.
Collapse
|
11
|
Sheikhtaheri A, Farzandipour M. Factors Associated with Quality of Informed Consent in Patients Admitted for Surgery: An Iranian Study. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/21507716.2010.528507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
12
|
Falagas ME, Korbila IP, Giannopoulou KP, Kondilis BK, Peppas G. Informed consent: how much and what do patients understand? Am J Surg 2009; 198:420-35. [PMID: 19716887 DOI: 10.1016/j.amjsurg.2009.02.010] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 02/10/2009] [Accepted: 02/16/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We sought to evaluate the degree of patients' understanding of several aspects of the informed consent process for surgery and clinical research. METHODS We conducted a systematic search of PubMed (1961-2006) to identify relevant articles. RESULTS We retrieved 23 and 30 eligible for inclusion articles regarding informed consent for surgery and clinical research, respectively. Regarding surgery, adequate overall understanding of the information provided and of the risks associated with surgery was shown in 6 of 21 (29%) and 5 of 14 (36%) studies providing relevant data, respectively. Regarding clinical research, adequate understanding of the aim of the study, the process of randomization, voluntarism, withdrawal, and the risks and the benefits of treatment was shown in 14 of 26 (54%), 4 of 8 (50%), 7 of 15 (47%), 7 of 16 (44%), 8 of 16 (50%), and 4 of 7 (57%) of studies providing relevant data, respectively. Satisfaction by the amount of the given information was shown in 7 of 12 (58%) studies involving surgery and 12 of 15 (80%) studies involving clinical research. CONCLUSIONS Further attention should be drawn on enhancing patients' understanding regarding several components of the informed consent process for surgery and clinical research.
Collapse
|
13
|
Mishra PK, Ozalp F, Gardner RS, Arangannal A, Murday A. Informed consent in cardiac surgery: is it truly informed? J Cardiovasc Med (Hagerstown) 2006; 7:675-81. [PMID: 16932081 DOI: 10.2459/01.jcm.0000243001.59675.bf] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To develop a validated questionnaire to measure how informed patients are when giving consent for elective coronary artery bypass grafting. METHODS We developed a questionnaire covering the domains described in the consent guidelines published by the General Medical Council. The questionnaire was developed for use in face-to-face interviews as opposed to a self-administered questionnaire. Interviews were conducted after the patients had given consent for surgery. A total of 41 patients were interviewed. To validate the questionnaire we tested the interobserver reliability by using four different interviewers and the construct validity by comparing it with area deprivation index and with predicted intelligence quotient scores obtained from the National Adult Reading Test. RESULTS The correlation of the ranking of the questions between the interviewers was satisfactory (Spearman's rank correlation coefficient, rs = 0.84-0.89). The total questionnaire scores correlated well with predicted intelligence quotient scores (rs = 0.48) but not with area deprivation index (rs = 0.01). Questions with the worst scores were those related to mortality, morbidity, alternative treatment options and their relative success rates and risks. CONCLUSIONS We have developed a validated questionnaire which tests patient's level of knowledge with respect to surgical myocardial revascularisation. Our study identified areas of informed consent where the minimal level of knowledge is below the recommended level. The questionnaire could be used in audits and clinical trials in patients undergoing coronary artery bypass grafting. It could be used as a tool to measure the effectiveness of patient education programmes. With appropriate changes, this instrument could also be applied in other fields of medical intervention, which require patients to give informed consent.
Collapse
|