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O'Neill F, O'Neill P, Schaffer S, Poullis A. The evolution of informed consent in gastroenterology. Med Leg J 2023; 91:204-209. [PMID: 37252897 DOI: 10.1177/00258172221141304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
With medical litigation on the rise, physicians require a nuanced understanding of the legalities of consenting patients to reduce their liability while practising evidence-based medicine. This study aims to a) clarify the legal duties of gastroenterologists in the UK and USA when gaining informed consent and b) provide recommendations at the international and physician level to improve the consent process and reduce liability.A bibliometric analysis of the Web of Science database with the MeSH terms "gastroenterology" and "informed consent" yielded 383 articles, of which 228 were excluded due to not meeting the inclusion criteria. Of the top 50 articles, 48% were from American institutions and 16% were from the UK. Thematic analysis showed 72% of the articles discussed informed consent in relation to diagnostic procedures, 14% regarding treatment, and 14% regarding research participation.Both the USA and the UK have progressed from previously paternalistic Natanson case (1960) and Bolam test (1957), respectively, where physicians were held to the standard of a "reasonable and prudent medical doctor". The American Canterbury case (1972) and the British Montgomery case (2015) radically shifted the standard of disclosure during the consent process by requiring physicians to explain all information pertinent to a "reasonable patient".It is our recommendation that a two-pronged approach be taken; a) creation of international guidelines for consenting patients for invasive procedures in gastroenterology, and b) development of internationally standardised endoscopy consent forms containing all the details pertinent to a "reasonable patient".
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Asgharzadeh F, Geraylow KR, Khazaei M, Nassiri M, Hassanian SM, Ferns GA, Avan A. Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers as Potential Therapeutic Options for Pancreatic Cancer. Curr Cancer Drug Targets 2022; 22:785-795. [PMID: 35585824 DOI: 10.2174/1568009622666220517104411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/27/2022] [Accepted: 02/15/2022] [Indexed: 11/22/2022]
Abstract
The renin-angiotensin system (RAS) has been reported to have a role in carcinogenesis, and therefore it may be of value as a potential therapeutic target in inhibiting tumor growth. It has been shown that inhibition of RAS via angiotensin I-converting enzyme inhibitors (ACEIs) and angiotensin II type-1 receptor (ARBs) inhibitors may have a protective effect against several malignancies. Here, we provide an overview of the potential value of the RAS pathway and targeting via ACE/ARB inhibitors in pancreatic cancer. Whilst the potential role of RAS as a target for the treatment of pancreatic cancer has been reported, the use of candesartan with gemcitabine failed to improve outcomes in pancreatic cancer. Another study of 1-3 years using ARB was found to reduce the risk of pancreatic cancer. In line with these trials, others have demonstrated that the ARBs in combination with gemcitabine might improve clinical outcomes in patients with advanced pancreatic cancer. Prospective trials are warranted to investigate this hypothesis.
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Affiliation(s)
- Fereshteh Asgharzadeh
- Department of Medical Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Majid Khazaei
- Department of Medical Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadreza Nassiri
- Recombinant Proteins Research Group, The Research Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Seyed Mahdi Hassanian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Medical Genetics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Xia T, Zhu YB, Zeng YB, Chen C, Wang SL, Zhao SB, Su XJ, Wang D, Yao J, Li ZS, Bai Y. Video education can improve awareness of risks for patients undergoing endoscopic retrograde cholangiopancreatography: A randomized trial. J Dig Dis 2019; 20:656-662. [PMID: 31618520 DOI: 10.1111/1751-2980.12824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 09/16/2019] [Accepted: 10/14/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We conducted a randomized trial aiming at improving patients' informed consent for undergoing endoscopic retrograde cholangiopancreatography (ERCP) in clinical care by comparing the efficacy of an additional educational video to written informed consent with that of written informed consent alone. METHODS This was a single-center, randomized controlled trial. Consecutive patients undergoing ERCP were randomized to a video education or a control group. An educational video detailing ERCP procedure plus standard written informed consent was administered to the video education group, while the control group reviewed standard written informed consent only. The primary outcome was the patients' perception of the risk or possibility of ERCP complications. Their perception of the benefits of ERCP, alternative treatments and overall satisfaction with the process of informed consent were also compared. RESULTS In total 205 patients were included in the study (104 in the control group and 101 in the video education group). Patients' comprehension of ERCP-related complications in the video education group was significantly increased (P < 0.001), and these patients were more likely to correctly identify the incidence of such complications. Significantly more patients in the video education group were very satisfied with informed consent process (87.1% vs 76.0%, P = 0.040) and fewer patients needed additional explanations (31.7% vs 47.1%, P = 0.024). CONCLUSIONS A supplementary educational video could greatly improve patient's understanding of ERCP procedure, in particular, its potential risks and complications, as well as their overall satisfaction with the process of informed consent (ClinicalTrials.gov no. NCT02810379).
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Affiliation(s)
- Tian Xia
- Department of Gastroenterology, Gongli Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.,Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Yang Bei Zhu
- Department of Gastroenterology, Shanghai Eighth People's Hospital, Shanghai, China
| | - Yan Bo Zeng
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Cui Chen
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Shu Ling Wang
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Sheng Bing Zhao
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Xiao Ju Su
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Dong Wang
- Department of Gastroenterology, Gongli Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.,Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Jun Yao
- Department of Gastroenterology, Jinan University of Second Clinical Medical Sciences, Shenzhen Municipal People's Hospital, Shenzhen, Guangdong Province, China
| | - Zhao Shen Li
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Yu Bai
- Department of Gastroenterology, Gongli Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.,Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
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Effect of Consent and Educational Adjuncts to Consent on Patient Perceptions About Colonoscopy. J Clin Gastroenterol 2019; 53:e316-e321. [PMID: 30001290 PMCID: PMC6329678 DOI: 10.1097/mcg.0000000000001093] [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] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Informed consent is a vital preprocedural step for endoscopy but there are substantial variations in its delivery. We therefore sought to assess a multifaceted intervention to improve the consent process. METHODS Gastroenterologists at a tertiary center were educated on the recommended components of informed consent. Following this, 3 cohorts of patients undergoing colonoscopy were surveyed before and after consent. In one cohort, the effect of optimized verbal consent alone was assessed. In the second and third groups, the effects of the addition of either a handout or a video describing colonoscopy and its risks were evaluated. The primary outcomes were the changes between preconsent and postconsent survey responses regarding confidence in understanding the procedure's purpose, likelihood of adverse events, and levels of anxiety. RESULTS In total, 240 patients were included with 79 to 81 patients per group. There were no significant differences among the groups' survey responses. Compared with patients receiving verbal consent alone, fewer patients in the handout and video groups increased their perceived risk of adverse events following consent, but this difference did not reach significance (P=0.08). Examining all groups together, anxiety levels changed significantly after consent (P=0.003), with 31% of patients reducing their anxiety level, 8% increasing it, and 62% having no change. CONCLUSIONS The consent process appears to decrease patient anxiety about colonoscopy. When used in conjunction with a high-quality verbal consent, written or video educational adjuncts provided on the day of colonoscopy likely have no effect on patient perceptions.
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Consenting patients for endoscopic retrograde cholangiopancreatography: results of a survey of 182 UK endoscopists and 2059 of their patients. Eur J Gastroenterol Hepatol 2009; 21:1351-7. [PMID: 19525853 DOI: 10.1097/meg.0b013e328305e175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe the endoscopic retrograde cholangiopancreatography (ERCP) consent process. METHOD A prospective, multicentre study of ERCP, supplemented by questionnaires administered to participating endoscopists and their patients. RESULTS A total 165 of 182 (91%) endoscopists completed a questionnaire describing personal practice with 140 of 165 (85%) routinely providing written information to patients; 120 of 165 (73%) routinely acquiring verbal consent on the day of ERCP; 23 of 165 (14%) delegating acquisition of consent to another team member and 59 of 165 (36%) usually/always describing alternative treatments to patients. Types of complication disclosed (and percentage of incidence quoted) varied significantly. A total of 2059 of 4561 (45%) patients completed the questionnaire following their first recorded procedure, at a mean of 11 days post-ERCP. Most (1968/2059; 96%) patients were satisfied with the explanation provided; they understood why ERCP was recommended (1935/2059; 94%) and recalled being informed of complications (1745/2059; 85%). Regression analysis of first-ever (nonurgent) ERCP suggested that patients were more likely to recall being informed of risk (odds ratio; 95% confidence interval) if they were younger (1.04 per 5-year decrease, 1.02-1.05), had an American Society of Anesthesiology score of less than 3 (2.0; 1.18-3.4); or had verbally consented more than 1 week in advance of ERCP (2.41, 1.02-5.71, when compared with those who consented on the day of ERCP). After ERCP 964 of 2059 (47%) patients were warned of specific symptoms that could arise. CONCLUSION The ERCP consent process could be improved by consistent disclosure of risk, acquisition of verbal consent well in advance of the procedure, provision of information after ERCP and increased attention to older and more sick patients.
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Siddins MT, Klinken EM, Vocale LR. Adequacy of consent documentation in a specialty surgical unit: time for community debate? Med J Aust 2009; 191:259-62. [DOI: 10.5694/j.1326-5377.2009.tb02779.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Accepted: 06/30/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Mark T Siddins
- Urology Unit, Repatriation General Hospital, Adelaide, SA
| | - Elizabeth M Klinken
- Flinders University School of Medicine, Adelaide, SA
- Sir Charles Gairdner Hospital, Perth, WA
| | - Lee R Vocale
- Flinders University School of Medicine, Adelaide, SA
- Austin Hospital, Melbourne, VIC
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