Dissatisfaction with consent for diagnostic gastrointestinal endoscopy

A Patient-Centered Approach to Communication during Endoscopic Procedures: The Importance of Providing Information to Patients

The study aimed to explore patients' experiences and perceptions throughout the various stages of endoscopic procedures and examine the association between patient-centered communication and the patient's experience. A total of 191 patients responded to pre- and post-procedure surveys that inquired about fear and pain, patients' satisfaction regarding the information provided to them, perceptions and experience. Pain was associated with post-procedure fear (r = 0.63, p < 0.01) and negatively associated with reported patient experience at the end of the visit (r = -0.17, p < 0.01). Significant positive associations were found between patient experience and satisfaction from the information provided before (r = 0.47, p < 0.01) and the information provided after the procedure (r = 0.51, p < 0.001). A predictive model found that perceptions toward the physicians, satisfaction from information provided before discharge, and feelings of trust are predictors of the patient experience (F = 44.9, R2 = 0.61, p < 0.001). Patients' satisfaction with information provided before and after the procedure can positively affect the patients' experience, leading to a decrease in fear and anxiety and increasing compliance with medical recommendations. Strategies for PCC with endoscopic patients should be developed and designed in a participatory manner, taking into account the various aspects associated with the patient experience.

Challenge of achieving truly individualised informed consent in therapeutic endoscopy

Objective

Guidance covering informed consent in endoscopy has been refined in the UK following the obstetric case of Nadine Montgomery, and in light of updated General Medical Council guidance. All risks likely to be material to the patient must be explored, as well as alternatives to the procedure. Despite this, departments and endoscopists still struggle to meet the current standards. In this article, we explore the challenges encountered in achieving individualised consent in therapeutic endoscopy through real-life scenarios.

Methods

Five realistic therapeutic endoscopy (hepatobiliary) scenarios are described, followed by presentation of possible or ideal approaches, with references related to existing literature in this field.

Results

The vignettes allow consideration of how to approach difficult consent challenges, including anxiety and information overload, urgency during acute illness, failure to disclose the risk of death, the role of trainees and intraprocedural distress under conscious sedation.

Conclusions

The authors conclude that a high degree of transparency is required while obtaining consent for therapeutic endoscopy accompanied by full documentation, involvement of relatives in nearly all cases, and clarity around the presence of trainees who may handle the scope. A greater focus on upskilling trainees in the consent process for therapeutic endoscopy is required.

Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopic Procedures: A Joint NASPGHAN/ESPGHAN Guideline

INTRODUCTION

High-quality pediatric gastrointestinal procedures are performed when clinically indicated and defined by their successful performance by skilled providers in a safe, comfortable, child-oriented, and expeditious manner. The process of pediatric endoscopy begins when a plan to perform the procedure is first made and ends when all appropriate patient follow-up has occurred. Procedure-related standards and indicators developed to date for endoscopy in adults emphasize cancer screening and are thus unsuitable for pediatric medicine.

METHODS

With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of endoscopic procedures. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach.

RESULTS

The PEnQuIN working group achieved consensus on 14 standards for pediatric endoscopic procedures, as well as 30 indicators that can be used to identify high-quality procedures. These were subcategorized into three subdomains: Preprocedural (3 standards, 7 indicators), Intraprocedural (8 standards, 18 indicators), and Postprocedural (3 standards, 5 indicators). A minimum target for the key indicator, "rate of adequate bowel preparation," was set at ≥80%.

DISCUSSION

It is recommended that all facilities and individual providers performing pediatric endoscopy worldwide initiate and engage with the procedure-related standards and indicators developed by PEnQuIN to identify gaps in quality and drive improvement.

Effect of Consent and Educational Adjuncts to Consent on Patient Perceptions About Colonoscopy

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.

Issues on informed consent for endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic operation with potential therapeutic risks. With the development of endoscopic techniques, the rate of performing ERCP is more and more higher and as a result, the rate of complications is increasing. Unfortunately, quite a few patients have little comprehension about the process of ERCP and its complications. This paper gives a brief overview of some issues on informed consent for ERCP.

Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS)

This document represents the first position statement produced by the British Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, setting out the minimum expected standards in diagnostic upper gastrointestinal endoscopy. The need for this statement has arisen from the recognition that while technical competence can be rapidly acquired, in practice the performance of a high-quality examination is variable, with an unacceptably high rate of failure to diagnose cancer at endoscopy. The importance of detecting early neoplasia has taken on greater significance in this era of minimally invasive, organ-preserving endoscopic therapy. In this position statement we describe 38 recommendations to improve diagnostic endoscopy quality. Our goal is to emphasise practices that encourage mucosal inspection and lesion recognition, with the aim of optimising the early diagnosis of upper gastrointestinal disease and improving patient outcomes.

Knowledge acquired, satisfaction attained and attitudes towards shared decision making in colorectal cancer screening

Background

Introducing shared decision making (SDM) in colorectal cancer (CRC) screening requires patients to acquire appropriate knowledge. We aimed to describe the knowledge attained by subjects with a family history of CRC.

Methods

Consecutive patients attending the gastroenterology clinic for a CRC family history were invited to take part in a cross-sectional survey. Attitudes towards SDM, satisfaction with the information received, knowledge currently achieved, and relevant influencing factors were evaluated. Satisfaction and attitudes towards SDM were evaluated with Likert scale questions. Knowledge was surveyed with closed (80%) and open (20%) questions.

Results

Of the 160 patients, 42.7% were male and the median age was 51.8 years (interquartile range: 43.9-58.5). Most subjects favored SDM; only 12.8% (8.4-19.1%) favored passive attitudes. Satisfaction with the information received about what a colonoscopy is and why it is recommended was adequate in 83.1% (76.4-88.2%). Information about risks satisfied 62.9% (55-70.1%) and about alternatives to colonoscopy only 30.6% (23.8-38.3%). The benefits of screening were better known than its risks and alternatives. The CRC decrease associated with screening was known to 71.3% (63.7-77.8%), but only 38.5% (31.1-46.4%) knew that a reduced risk still exists. Just 21.2% (15.5-26.9%) could mention an alternative screening method to colonoscopy and only 42.5% (35-50.4%) were aware of any associated harm. On multivariate analysis, higher educational level and younger age of the attending physician were associated with higher knowledge scores.

Conclusion

SDM is considered favorably by most patients. Although information about the benefits of CRC screening is transmitted adequately, risks and alternatives should be better addressed.

Assessment of the effectiveness of SFCR patient information sheets before scheduled spinal surgery

INTRODUCTION

Patient information is an essential component of any surgical procedure as it allows the surgeon to collect informed consent. This is a legal obligation in the civil code and a professional obligation in the code of medical ethics. As a result, the French spinal surgery society (SFCR) decided to make a model information sheet available on the Internet. The goal of this prospective study was to evaluate the impact of this information sheet when given to patients before scheduled spinal surgery.

METHODS

This was a single-centre prospective study performed between November 2014 and February 2015. Seventy patients filled out two questionnaires. The first was about the quality of the medical information given orally by the surgeon; it was administered to patients after the preoperative consultation. The second was about the quality of the medical information contained in the information sheet; it was administered after patients had read this sheet. For each of the questions, patients could either select "yes" if they found the information to be correct/useful (1 point) or "no" if not (0 point).

RESULTS

The mean patient age was 56.7 years (range: 28-86). The average number of "yes" answers was 7.07 (out of 12) in the first questionnaire. The average number of "yes" answers was 10.3 (out of 12) after reading the information sheet. This indicates that patients were significantly better informed after reading the SFCR sheet. The written document was deemed to be understandable (mean: 8/10). It answered the patients' questions (mean: 6.7/10) and helped them understand how the surgical procedure would be carried out (mean: 7.3/10). The patients' level of education did not significantly alter these findings.

CONCLUSION

Adding a written SFCR information sheet to the preoperative consultation improved patients' understanding before scheduled spine surgery.

LEVEL OF EVIDENCE

Low-powered prospective study.

Informed consent in colonoscopy: A comparative analysis of 2 methods

BACKGROUND

The manner in which informed consent is obtained varies. The aim of this study is to evaluate the level of knowledge about colonoscopy and comparing 2 methods of obtaining informed consent.

MATERIALS AND METHODS

A comparative, cross-sectional, observational study was conducted on patients that underwent colonoscopy in a public hospital (Group A) and in a private hospital (Group B). Group A received information verbally from a physician, as well as in the form of printed material, and Group B only received printed material. A telephone survey was carried out one or 2 weeks later.

RESULTS

The study included a total of 176 subjects (group A [n=55] and group B [n=121]). As regards education level, 69.88% (n=123) of the patients had completed university education, 23.29% (n= 41) secondary level, 5.68% (n=10) primary level, and the remaining subjects (n=2) had not completed any level of education. All (100%) of the subjects knew the characteristics of the procedure, and 99.43% were aware of its benefits. A total of 97.7% received information about complications, 93.7% named some of them, and 25% (n=44) remembered major complications. All the subjects received, read, and signed the informed consent statement before the study. There were no differences between the groups with respect to knowledge of the characteristics and benefits of the procedure, or the receipt and reading of the consent form. Group B responded better in relation to complications (P=.0027) and group A had a better recollection of the major complications (P<.0001). Group A had a higher number of affirmative answers (P<.0001).

CONCLUSIONS

The combination of verbal and written information provides the patient with a more comprehensive level of knowledge about the procedure.

Assessment of delivery methods used in the informed consent process at a safety-net hospital

BACKGROUND

Informed consent is legally and ethically required before a patient undergoes an endoscopic procedure, yet current literature suggests that patient comprehension of key components of informed consent is poor.

OBJECTIVE

To evaluate specific aspects of and patient satisfaction with the informed consent process in patients who attended an endoscopy education class versus gastroenterology clinic.

DESIGN

Prospective survey that examined all components of the informed consent process.

SETTING

Safety-net hospital.

PATIENTS

Outpatients undergoing endoscopy.

INTERVENTION

Endoscopy education class versus gastroenterology clinic.

MAIN OUTCOME MEASUREMENTS

Patient recall of the components of and satisfaction with the informed consent process.

RESULTS

A total of 301 patients completed the survey, 52.0% of whom attended and were consented in an endoscopy education class. Patients who attended an endoscopy education class reported that a greater number of individual components of the informed consent process were explained to them as compared with patients who were consented in clinic. In multivariate analysis, patients who attended an education class were more likely to recall having had the alternatives (odds ratio [OR] 4.8; 95% confidence interval [CI], 2.0-11.8), details of the procedure (OR 3.0; 95% CI, 1.3-6.8), and what to expect after the procedure (OR 3.0; 95% CI, 1.5-5.6) explained to them by a provider. These patients were more likely to know they could refuse the procedure (OR 4.1; 95% CI, 1.0-16.8), compared with patients consented in the gastroenterology clinic.

LIMITATIONS

Non-randomized trial.

CONCLUSION

Patients from a diverse, urban population who attended a multilingual endoscopy education class reported having more elements of the informed consent process explained to them compared with patients who were consented in gastroenterology clinic.

The Global Rating Scale in clinical practice: a comprehensive quality assurance programme for endoscopy departments

BACKGROUND

The Global Rating Scale is an endoscopy quality assurance programme, successfully implemented in England. It remains uncertain whether it is applicable in another health care setting.

AIM

To assess the applicability of the Global Rating Scale as benchmark tool in an international context.

METHODS

Eleven Dutch endoscopy departments were included for a Global Rating Scale-census, performed as a cross-sectional evaluation, July 2010. Two Global Rating Scale-dimensions - 'clinical quality' and 'patient experience' - were assessed across six items using a range of levels: from level-D (basic) to level-A (excellent). Construct validity was assessed by comparing department-specific colonoscopy audit data to GRS-levels.

RESULTS

For 'clinical quality', variable scores were achieved in items 'safety' (9%=B, 27%=C, 64%=D) and 'communication' (46%=A, 18%=C, 36%=D). All departments achieved a basic score in 'quality' (100%=D). For 'patient experience', variable scores were achieved in 'timeliness' (18%=A, 9%=B, 73%=D) and 'booking-choice' (36%=B, 46%=C, 18%=D). All departments achieved basic scores in 'equality' (100%=D). Departments obtaining level-C or above in 'information', 'comfort', 'communication', 'timeliness' and 'aftercare', achieved significantly better audit outcomes compared to those obtaining level-D (p<0.05).

CONCLUSION

The Global Rating Scale is appropriate to use outside England. There was significant variance across departments in dimensions. Most Global Rating Scale-levels were in line with departments' audit outcomes, indicating construct validity.

Informed consent for digestive endoscopy

Informed consent is necessary in good clinical practice. It is based on the patient´s ability to understand the information about the proposed procedure, the potential consequences and complications, and alternative options. The information is written in understandable language and is fortified by verbal discussion between physician and patient. The aim is to explain the problem, answer all questions and to ensure that the patient understands the problems and is able to make a decision. The theory is clear but what happens in daily practice?

Percutaneous liver biopsy: patients' point of view

INTRODUCTION

Hepatic fibrosis can be assessed through serum markers or by the implementation of new non-invasive techniques, such as elastography. We must know patients' opinion on percutaneous liver biopsy (PLB) when it comes to comparing it with other procedures.

AIMS

To know the point of view of patients undergoing a PLB with regard to information provided to them, as well as the procedures and biopsy consequences.

PATIENTS AND METHODS

A questionnaire was sent by mail to 178 patients who underwent PLB from April 2006 to May 2010. Answers were analyzed. Results are expressed in percentages and compared based on gender and age (younger or older than 47 years of age) (Chi-square test).

RESULTS

Ninety patients of the group answered, 44 females, mean age 47 ± 12 years. The answers revealed that 93% of patients rated the information concerning the reasons for a PLB as adequate (86% women and 100% men). As for the information concerning the objective of the procedure, 88% of patients regarded it as adequate (81% of women vs. 93% of men, p = 0.08). As for the information concerning the risks of a biopsy, 77.7% see it as sufficient. About 12.20% of patients did not receive any information on the physician who asked for the PLB, or who performed it. PLB was considered very painful by 14% of patients, painful by 21%, bothersome by 41.1% and barely bothersome by 23% of patients. Thirty-five percent of patients required analgesia after the puncture. Even though 92% of patients regard PLB as a useful procedure, 46% of them have not received any treatment or a different nutritional regime (55.8%, among those older than 47 years of age, p = 0.03). Eighty percent of patients think that PLB has more benefits than drawbacks, although 87% would have opted for a less aggressive technique as long as it would have provided the same information. But 21% of patients would have also preferred a less aggressive technique, even though it provided fewer details.

CONCLUSIONS

In general, PLB is widely approved by patients and is also regarded as a useful procedure. One out of six patients would rather choose a less-aggressive technique even if it provided less information. PLB does not involve changes in the treatment in around a half of patients.

A prospective audit of patient experiences in colonoscopy using the Global Rating Scale: a cohort of 1,187 patients

BACKGROUND

The Global Rating Scale (GRS) comprehensively evaluates the quality of an endoscopy department, providing a patient-centred framework for service improvement.

OBJECTIVE

To assess patient experiences during colonoscopy and identify areas that need service improvement using the GRS.

METHODS

Consecutive outpatients undergoing colonoscopy were asked to complete a pre- and postprocedure questionnaire. Questions were based on GRS items and a literature review. The preprocedure questionnaire addressed items such as patient characteristics and information provision. The postprocedure questionnaire contained questions regarding comfort, sedation, the attitude of endoscopy staff and aftercare.

RESULTS

The preprocedure questionnaire was completed by 1,187 patients, whereas the postprocedure part of the questionnaire was completed by 851 patients (71.9%). Fifty-four per cent of patients were first seen in the outpatient clinic. The indication for colonoscopy was explained to 85% of the patients. Sixty-five per cent of the patients stated that information about the risks of colonoscopy was provided. Sedation was used in 94% of the patients; however, 23% judged the colonoscopy to be more uncomfortable than expected. Ten per cent of patients rated the colonoscopy as (very) uncomfortable. Preliminary results of the colonoscopy were discussed with 87% of patients after the procedure. Twenty-one per cent of the patients left the hospital without knowing how to obtain their final results. Being comfortable while waiting for the procedure (OR 9.93) and a less uncomfortable procedure than expected (OR 2.99) were important determinants of the willingness to return for colonoscopy.

CONCLUSIONS

The present study provided evidence supporting the GRS in identifying service gaps in the quality of patient experiences for colonoscopy in a North American setting. Assessing experiences is useful in identifying areas that need improvement such as the provision of pre- and postprocedure information.

Acceptance and understanding of the informed consent procedure prior to gastrointestinal endoscopy by patients: a single-center experience in Korea

BACKGROUND/AIMS

Only a few reports have examined informed consent for gastrointestinal endoscopy in Korea. The aim of this study was to evaluate the appropriateness of the informed consent procedure in Korea.

METHODS

A total of 209 patients who underwent endoscopy were asked to answer a self-administered structured questionnaire on the informed consent procedure for gastrointestinal endoscopy.

RESULTS

One hundred thirteen patients completed questionnaires and were enrolled. In the survey, 91.2% answered that they understood the procedure, and the degree of understanding decreased with age; 85.8% were informed of the risks of the procedure, and the proportion was higher for inpatients and for those receiving therapeutic endoscopy or endoscopic retrograde cholangiopancreatography; 60.2% were informed of alternative methods, and the proportion was higher in older patients; 76.1% had the opportunity to ask questions during the informed consent procedure, and the proportion was higher in inpatients. The understanding of the risks of the endoscopic procedure was better in the younger and more highly educated groups. About 80% had sedation before endoscopy, and only 56% were informed of the risks of sedation during endoscopy.

CONCLUSIONS

The current informed consent process may be reasonably acceptable and understandable to the patients. However, the understanding of the risks of endoscopy was insufficient especially in the cases of older, poorly educated patients and outpatients. The information about alternatives, the opportunity to ask for additional information, and the information about the risks of sedation during endoscopy were also insufficient in the current consent process.

Clinical outcomes associated with attempts to educate patients about lower endoscopy: a narrative review

Patient knowledge about lower endoscopy might have beneficial effects on satisfaction outcomes, pre-procedure anxiety, and adherence, although this is poorly understood. Methods Searching the national and international literature, we reviewed 20 years of observational studies and randomized trials that examine possible relationships between educating patients about lower endoscopy and clinical outcomes. Twenty-three publications were included but their heterogeneity precluded meta-analyses. Standard and modified informed consent procedures and enhanced educational interventions were associated most often with levels of patient knowledge, satisfaction, anxiety, and adherence. Regardless of the approach, a large proportion of patients have poor comprehension of lower endoscopy's risks, benefits, and alternatives; patient satisfaction with information and procedures manifests ceiling effects; only a subset of patients have clinically significant pre-procedure anxiety; and providing written information and reminders may improve procedure adherence. Future work should focus on strategies for improving patient knowledge in the setting of initial screening colonoscopy within open access systems. Patient knowledge of lower endoscopy is often inadequate even though greater knowledge might be associated with better clinical outcomes for certain patient subgroups. Professional societies have an important role to play in endorsing educational strategies and in clarifying and assessing the adequacy of patient knowledge.

Complications of ERCP: ethical obligations and legal consequences

Endoscopic retrograde cholangiopancreatography (ERCP) is a skill and technique demanding high-risk procedure with an overall complication rate of about 5-10%. Pancreatitis remains the most common complication of ERCP, however, bleeding after sphincterotomies, infections and cardiopulmonary complications as well as perforations may also occur. Patient- and procedure-related risk factors of ERCP complications are mainly predictable so that ERCP often can be avoided and substituted for alternative imaging techniques, especially in high-risk patients. Written consent should be obtained for any ERCP to provide documentary evidence that explanation of the proposed procedure and endoscopic treatment was given and that consent was sought and obtained. The investigating doctor remains responsible for ensuring sufficient time for the patient's questions and to make informed decision before the start of any procedure. The most common legal consequence of an ERCP complication is a civil negligence claim for compensation, however, a clinician may in rare cases be faced with criminal proceedings where there is evidence of gross negligence. Analysis of claims against gastroenterologists suggests the conclusion that ERCP should be done for good indications, by trained endoscopists with standard techniques, with good, documented, patient-informed consent and communication before and after the procedure.

Informed consent in direct access colonoscopy

BACKGROUND AND AIM

Although direct access colonoscopy is a common practice, some consider the level of informed consent as inadequate, and therefore a medico-legal concern. The aim of this study was to assess the adequacy of informed consent from a patient perspective in a direct access colonoscopy service.

METHODS

All patients having outpatient colonoscopy from May 2003 to February 2004 at a direct access colonoscopy service were considered for inclusion into the study. Information was obtained from patients by structured questionnaire administered either at the time of discharge from the day ward or mailed to their homes.

RESULTS

Information was obtained from 346 direct access colonoscopy patients (172 male, 159 female; 226 >or= 50 years, 103 < 50 years), 80% of whom were referred by their family doctor. Colonoscopy was done for investigation of symptoms in 220 patients, and for screening and surveillance in 115 patients, with an indication not specified in 11 patients. The majority of patients were either very satisfied (70.5%) or satisfied (25.1%) with the consent process, with no demographic characteristics found to predict dissatisfaction. Thirty-seven patients expressed a preference to have seen a gastroenterologist prior to colonoscopy, and four of these patients reported the consent process to be unsatisfactory. Seventy (20.2%) patients reported that the most useful information about colonoscopy was received after they had completed bowel preparation.

CONCLUSION

No demographic characteristics were found to predict the small fraction of patients dissatisfied with the informed consent process. Further medico-legal risk reduction may be facilitated by enhancing the provision of information prior to bowel preparation.

Patient information for liver biopsy: impact of a video movie

AIMS

The information given to patients before a medical procedure is usually delivered verbally and in the form of a written document. Viewing a video movie about the procedure might be helpful in improving the quality of patient information and thus contributed to reduce patient anxiety. The aim of this prospective study on the methods used to deliver information to patients scheduled for liver biopsy was to determine, in comparison with standard information delivery, the impact on anxiety and understanding of additional information provided by a video movie.

METHODS

Patients included in this study were scheduled for liver biopsy. Three days before the procedure, a physician informed the patients about liver biopsy and gave them a written information document. After this standard information delivery, the patients were randomly assigned to two groups, to view or not a video movie illustrating liver biopsy and recalling the information provided in the information document. Anxiety was measured after the information visit and just before the biopsy procedure using Spielberger's self-administered STAI-Y questionnaire. Patient understanding of and satisfaction with the information received were evaluated respectively before and after the procedure.

RESULTS

Among the 67 patients retained for analysis, 33 viewed the information video and 34 did not. The level of anxiety measured at the information visit and before liver biopsy was similar in the two groups (38.8 and 37.4 with video versus 38.9 and 40.1 without video). The patients had an excellent understanding of the information received (12.3/14 with video; 12.7/14 without video) and were well satisfied with the information received.

CONCLUSION

The patients understood and were well satisfied with the information received about liver biopsy. Complementary information in the form of a video movie had no effect on patient anxiety.

Medical malpractice litigation related to gastrointestinal endoscopy in Japan: A two-decade review of civil court cases

AIM: To examine the allegations in malpractice litigations related to gastrointestinal endoscopy in Japan.

METHODS: A retrospective review of cases tried in the civil court system during the 21-year period from 1985 to 2005, identified in a computerized legal database, was undertaken.

RESULTS: Eighteen malpractice litigations and a total of 30 allegations were identified. Of the 18 (44%) malpractice litigations, 8 (44%) were related to eso-phagogastroduodenoscopy, 4 (22%) to colonoscopy, 4 (22%) to endoscopic sphincterotomy, and 2 (11%) to endoscopic retrograde cholangiopancreatography. Seventeen (94%) cases pertained to complications, and the remaining (6%) case pertained to misdiagnosis. In 10 cases, the patient died of the complications. Allegations were categorized as: (1) performance error during the endoscopic procedure (n = 12, 40%); (2) lack of informed consent (n = 9, 30%); (3) performance error during the treatment after the endoscopic procedure (n = 4, 13%); (4) premedication error (n = 3, 10%); (5) diagnostic error (n = 1, 3%); and (6) indication error for the endoscopic procedure (n = 1, 3%).

CONCLUSION: These data may aid in the design of risk prevention strategies to be used by gastrointestinal endoscopists.

Patient feedback on helpfulness of postal information packs regarding informed consent for endoscopic procedures

BACKGROUND

Informed consent is an important part of any medical procedure.

OBJECTIVE

Our objective was to assess the impact of postal information on the understanding of consenting for gastrointestinal endoscopy.

DESIGN

Cross-sectional survey.

SETTING

District hospital, United Kingdom.

PATIENTS

A total of 1800 patients who attended and 314 patients who did not attend (DNA) for GI endoscopy.

INTERVENTIONS

The patients' views questionnaire was given out at discharge to attendees and mailed to nonattendees after the proposed date of the procedure with a reassurance of anonymity.

MAIN OUTCOME MEASUREMENTS

Survey responses.

RESULTS

A total of 906 (43%) of the questionnaires were returned (DNAs = 60). Most responders felt the information supplied was appropriate. The majority felt the information supplied either helped them make an informed decision or raised further questions. However, a proportion of respondents felt it made no difference to their decision making. The majority (73%) preferred to know the risks. Of the 398 responses obtained in relation to preference of display of risks, 10.8% were not bothered if the risk was rare (ie, less than 1 in 1000) and 18.6% were interested in the complication rate of the endoscopist performing their procedure From the DNA group, 8.3% had been influenced by the information provided.

LIMITATIONS

Lack of literacy check and suboptimal subject participation.

CONCLUSIONS

Obtaining consent should be an individualized process tailored to the patients' needs. Patient preference for information and risk disclosure is variable but may be more than what is currently given in current clinical practice. Further research is needed to improve this communication process.

Patients' informational needs and information received do not correspond in hospital

AIMS AND OBJECTIVES

This study describes and compares the information patients want with the information they receive and examines whether this varies between patients.

BACKGROUND

Patient information during hospitalization has received increasing attention. Previous studies, however, have identified problems of inadequate or insufficient information from a patient's point of view.

DESIGN

Descriptive, survey design with questionnaires.

METHODS

The categorical data were collected by specifically designed questionnaires from adult patients (n = 928) on discharge from one Finnish hospital. The data were analysed statistically using descriptive statistics and non-parametric tests (Mann-Whitney U, Kruskal-Wallis, McNemar and Wilcoxon Signed Ranks tests).

RESULTS

Patients attached great importance to information on illness and treatment, and information in this area was provided quite satisfactorily. Less importance was attached to information regarding patient's daily management of illness, such as aftercare, prognosis and patients' rights and less information was reportedly provided. Female gender was systematically associated with attaching greater importance to information and to better evaluations of informational areas.

CONCLUSIONS

Patients informational needs and the information received from staff did not correspond. The findings confirm the importance of nurses' roles in assessing patients' informational needs to tailor and provide explicit and relevant information to satisfy patients' informational needs.

RELEVANCE TO CLINICAL PRACTICE

More emphasis should be put on developing methods to ascertain patients' informational needs, to evaluate the content of information and to develop tailored information packages for different patients. This can be done by empowering and helping patients to access and understand relevant and appropriate information, for example, by Web-based information systems.

An audit of informed consent in gastroscopy: investigation of a hospital's informed consent procedure in endoscopy by assessing current practice

OBJECTIVE

To investigate, by assessing current practice, whether a UK general hospital's informed consent procedure in endoscopy was implemented for all patients, because informed consent is central to the proper conduct of endoscopic procedures.

METHODS

A retrospective study of patients' medical notes, in which information written on the UK National Health Service (NHS) consent form and on a departmental leaflet on the gastroscopy procedure completed by the patient was assessed. Sampling began from 9 October 2003 until 100 patients were recorded. For each patient's record, a data collection sheet was completed.

RESULTS

Of the 67 patient records assessed (33 were unavailable), all contained the NHS consent form with signatures from the practitioner and patient. The departmental leaflet was present for only 31 patients, and of these, 20 had a signature from the patient and one leaflet had a signature from the practitioner. The multiple choice test was completed for 28 of the 31 departmental leaflets and full marks were awarded for 17 of 28. Although 11 patients answered one or more questions incorrectly, a discussion of the correct answers was only found in two records.

CONCLUSION

To achieve improved performance, a training/induction programme should explain the informed consent procedure and its importance. This should be supported by 'booster' training sessions to avoid the emergence of bad practice. These sessions should take advantage of evidence-based medicine via feedback from audits and discussions of litigation cases. Departmental leaflets and NHS consent forms should also be provided in other languages.