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Kiernan A, Boland F, Naughton P, Moneley D, Doyle F, Harkin DW. Varicose Vein Education and Informed coNsent (VVEIN) Study: A Randomized Controlled Pilot Feasibility Study. Ann Vasc Surg 2024; 106:142-151. [PMID: 38810723 DOI: 10.1016/j.avsg.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The primary aim of this study was to assess the feasibility of introducing a digital health education tool (dHET) for varicose vein surgery. METHODS This randomized, feasibility study allocated 40 patients, into dHET (n = 20) or standard consent (SC) (n = 20) groups. Primary outcomes were related to feasibility. Secondary outcomes were knowledge recall, anxiety, and satisfaction. RESULTS Recruitment and retention rates were 100% and 97.5%, respectively. Acceptability was also rated high, confirming feasibility. There was also no evidence of a difference between groups for early knowledge recall (14 [12-17] vs. 14 [11-16]; P = 0.72) or delayed (at 2 weeks) knowledge recall (15 [13-16] vs. 15 [13-16]; P = 0.89). The dHET module took significantly longer to complete compared to SC (13 min [12-18] vs. 9 min [8-12]; P < 0.01). However, the control group asked significantly more questions about the intended procedure (P = 0.03). There was no evidence of a difference between groups for patient anxiety or satisfaction. CONCLUSIONS This trial shows that the addition of a dHET is feasible and noninferior to SC. Digital consent provides a unique opportunity to promote patient education and autonomy for better shared decision making. It also offers better documentation of the consent process.
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Affiliation(s)
- Aoife Kiernan
- Strategic Academic Research (StAR) Programme, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland.
| | - Fiona Boland
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Peter Naughton
- Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland; Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Daragh Moneley
- Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland; Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Denis W Harkin
- Strategic Academic Research (StAR) Programme, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland; Department of Medical Professionalism, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Felder RM, Luenprakansit K, Pope TM, Magnus D. Making Medical Treatment Decisions for Unrepresented Hospitalized Patients. Am J Med 2024; 137:473-475. [PMID: 38336083 DOI: 10.1016/j.amjmed.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Ryan Marshall Felder
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Calif.
| | - Kate Luenprakansit
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Calif
| | | | - David Magnus
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Calif
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Surgical informed consent: new challenges. Curr Probl Surg 2023; 60:101258. [PMID: 36813352 DOI: 10.1016/j.cpsurg.2022.101258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
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Kiernan A, Fahey B, Guraya SS, Boland F, Moneley D, Doyle F, Harkin DW. Digital technology in informed consent for surgery: systematic review. BJS Open 2023; 7:7000436. [PMID: 36694387 PMCID: PMC9874030 DOI: 10.1093/bjsopen/zrac159] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/03/2022] [Accepted: 10/26/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Informed consent is an ethical and legal requirement in healthcare and supports patient autonomy to make informed choices about their own care. This review explores the impact of digital technology for informed consent in surgery. METHODS A systematic search of EBSCOhost (MEDLINE/CINAHL), Embase, Cochrane Central Register of Controlled Trials and Web of Science was performed in November 2021. All RCTs comparing outcomes of both digital and non-digital (standard) consent in surgery were included. Each included study underwent an evaluation of methodological quality using the Cochrane risk of bias (2.0) tool. Outcomes assessed included comprehension, level of satisfaction and anxiety, and feasibility of digital interventions in practice. RESULTS A total of 40 studies, across 13 countries and 15 surgical specialties were included in this analysis. Digital consent interventions used active patient participation and passive patient participation in 15 and 25 studies respectively. Digital consent had a positive effect on early comprehension in 21 of 30 (70 per cent) studies and delayed comprehension in 9 of 20 (45 per cent) studies. Only 16 of 38 (42 per cent) studies assessed all four elements of informed consent: general information, risks, benefits, and alternatives. Most studies showed no difference in satisfaction or anxiety. A minority of studies reported on feasibility of digital technology in practice. CONCLUSION Digital technologies in informed consent for surgery were found to have a positive effect on early comprehension, without any negative effect on satisfaction or anxiety. It is recommended that future studies explore the feasibility of these applications for vulnerable patient groups and busy surgical practice.
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Affiliation(s)
- Aoife Kiernan
- Correspondence to: Aoife Kiernan, RCSI Main Building, 123 St Stephen’s Green, Dublin 2, Ireland (e-mail: )
| | - Brian Fahey
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Shaista S Guraya
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland—Bahrain, Busaiteen, Bahrain
| | - Fiona Boland
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daragh Moneley
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Denis W Harkin
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Does the standard medical procedure consent process meet the criteria required for informed consent? - A concept analysis. Nurs Outlook 2023; 71:101916. [PMID: 36681563 DOI: 10.1016/j.outlook.2022.101916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/12/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Informed consent is a complex process that is legally required before any surgical procedure. PURPOSE The purpose of this manuscript was to perform a concept analysis of the informed consent process. METHODS The use of dimensional analysis identified three separate yet related perspectives of the informed consent process: legal, health care, and patients. A database search using the Cumulative Index to Nursing and Allied Health Literature and PubMed were performed. FINDINGS A total of 27 publications were reviewed. The legal perspective addresses the requirement of informed consent, which starts with the discussion between the health care provider and the patient undergoing the surgical procedure and ends with a signature on a piece of paper. The health care perspective also addresses the legal requirement but incorporates the goals and objectives of the individual initiating the informed consent discussion. The patients' perspectives also incorporate goals and objectives; however, they differ from that of the health care provider in that they go beyond what happens in the operating room or during hospitalization. DISCUSSION Viewing informed consent through these different yet related perspectives provides insight into this complex process and may enhance the researcher's ability to understand and improve the informed consent process.
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Negash W, Assefa N, Baraki N, Wilfong T. Practice and Factors Associated with Informed Consenting Process for Major Surgical Procedures Among Health-Care Workers, South Eastern Ethiopia. Int J Gen Med 2021; 14:7807-7817. [PMID: 34795501 PMCID: PMC8593840 DOI: 10.2147/ijgm.s338243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Medical malpractice, poor patient outcome and medical suits among health-care workers result from improper consenting practices. Therefore, this study aimed to assess practice and factors associated with the informed consenting process for major surgical procedures among health-care workers in public hospitals of Bale Zone, South Eastern Ethiopia. Methods An institutional-based cross-sectional study was conducted from March 9 to 24, 2020, among all nurses, midwives, doctors (general physicians, surgeons, gynecologists), emergency surgery officers, anesthetists) who were working at Bale Zone public hospitals during the study period. A self-administered pretested questionnaire was employed. Variables with a p-value of less than 0.25 (age group, sex, educational profession, working unit, work experience, adequate content of consent form, training on informed consent, policy/regulation in institution, administrative support, average number of patient cared per shift, time spent for consent process, knowledge, attitude) at 95% confidence interval in the binary logistic regression analysis were considered for multivariable regression model to control for possible confounding effect. Results Of the total sample size (639 health-care workers), 621 (97.2%) were included in this study, of which 311 (50.1%, 95% CI: 46.1-53.8) practiced proper informed consent during major surgical procedures. Being age above 35 (AOR: 3.032, 95% CI: 1.148-8.010), male (AOR: 1.607, 95% CI: 1.047-2.465), above 10 years of working experience (AOR: 2.339, 95% CI: 1.104-4.955), adequate content of consent form (AOR: 2.785, 95% CI: 1.772-4.377), having training on informed consent (AOR: 2.305, 95% CI: 1.204-4.414), spending more time (>30minutes) for consent process (AOR: 3.014, 95% CI: 1.095-8.298), having good knowledge (AOR: 1.808, 95% CI: 1.195-2.737) and favorable attitude (AOR: 2.188, 95% CI: 1.456-3.287) were significantly associated with good informed consent practice. Conclusion Only half of health-care workers practiced good informed consent. Further emphasis needs to be given to improve consent practice.
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Affiliation(s)
- Wogene Negash
- Nursing Department, School of Health Science, Madda Walabu University Goba Referral Hospital, Goba, Ethiopia
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Negga Baraki
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Tara Wilfong
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
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McCauley N, Lodhia S, Ong A, Clark C, Lane T. Informed consent: What risks are material to patients consenting for urological procedures? JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211002950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to assess patient recall of the consent discussion for urological procedures and to identify which risks were material to urology patients. Methods: A total of 102 patients undergoing urological procedures were interviewed in the 24-hour period surrounding the procedure. A self-designed, piloted questionnaire recorded information from the patient’s signed consent form and patient-reported data of the consent discussion. Results: The mean patient recall was 2.06 risks, whereas the average number of risks listed by the operating surgeon on the consent form was 5.69 risks. The most frequently recalled risk was impotence (91%), followed by urinary incontinence (63%) and haematuria (61%). The risks associated with poorest patient recall were stent symptoms (0%), urethral catheter insertion (5%) and recurrence (8%). Conclusions: Poor patient recall of the consent discussion has again been demonstrated in this study. However, certain urological procedure risks are better recalled by patients, with impotence, urinary incontinence and haematuria being most frequently recalled. Medical terminology such as stent or catheter may be poorly recalled due to a disparity in understanding between patient and clinician. Clinicians should be aware of poor patient recall when consenting for urology procedures and should ensure precise documentation. Level of evidence: Level 2b.
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Affiliation(s)
| | | | | | - Calum Clark
- Guys and St Thomas’ NHS Foundation Trust, UK
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Schofield G, Dittborn M, Selman LE, Huxtable R. Defining ethical challenge(s) in healthcare research: a rapid review. BMC Med Ethics 2021; 22:135. [PMID: 34587950 PMCID: PMC8479723 DOI: 10.1186/s12910-021-00700-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/03/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Despite its ubiquity in academic research, the phrase 'ethical challenge(s)' appears to lack an agreed definition. A lack of a definition risks introducing confusion or avoidable bias. Conceptual clarity is a key component of research, both theoretical and empirical. Using a rapid review methodology, we sought to review definitions of 'ethical challenge(s)' and closely related terms as used in current healthcare research literature. METHODS Rapid review to identify peer-reviewed reports examining 'ethical challenge(s)' in any context, extracting data on definitions of 'ethical challenge(s)' in use, and synonymous use of closely related terms in the general manuscript text. Data were analysed using content analysis. Four databases (MEDLINE, Philosopher's Index, EMBASE, CINAHL) were searched from April 2016 to April 2021. RESULTS 393 records were screened, with 72 studies eligible and included: 53 empirical studies, 17 structured reviews and 2 review protocols. 12/72 (17%) contained an explicit definition of 'ethical challenge(s), two of which were shared, resulting in 11 unique definitions. Within these 11 definitions, four approaches were identified: definition through concepts; reference to moral conflict, moral uncertainty or difficult choices; definition by participants; and challenges linked to emotional or moral distress. Each definition contained one or more of these approaches, but none contained all four. 68/72 (94%) included studies used terms closely related to synonymously refer to 'ethical challenge(s)' within their manuscript text, with 32 different terms identified and between one and eight different terms mentioned per study. CONCLUSIONS Only 12/72 studies contained an explicit definition of 'ethical challenge(s)', with significant variety in scope and complexity. This variation risks confusion and biasing data analysis and results, reducing confidence in research findings. Further work on establishing acceptable definitional content is needed to inform future bioethics research.
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Affiliation(s)
- Guy Schofield
- Centre for Ethics in Medicine, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
| | - Mariana Dittborn
- Paediatric Bioethics Centre, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Lucy Ellen Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Richard Huxtable
- Centre for Ethics in Medicine, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
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Alomar AZ. Confidence level, challenges, and obstacles faced by orthopedic residents in obtaining informed consent. J Orthop Surg Res 2021; 16:390. [PMID: 34140032 PMCID: PMC8212467 DOI: 10.1186/s13018-021-02531-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The objective is to evaluate the opinions of orthopedic residents on current practices, experiences, training, confidence level, difficulties, and challenges faced when obtaining informed consent. DESIGN This is a cross-sectional, multi-center, and questionnaire-based study. SETTING The study was done in forty-four training centers across Saudi Arabia. PARTICIPANTS In total, 313 orthopedic residents participated. MATERIAL AND METHODS The web-based questionnaire examined the perceptions of residents regarding practices, experience, training, difficulties, and challenges surrounding the obtention of informed consent, as well as residents' confidence in obtaining informed consent for different orthopedic situations and eight common orthopedic procedures. RESULTS Most residents were allowed to obtain consent independently for all emergency, trauma, primary, and revision cases at their institution (92.7%). Only 33.5% of the residents received formal training and teaching on obtaining informed consent, with 67.1% having believed that they needed more training. Only 4.2% of the residents routinely disclosed all essential information of informed consent to patients. Inadequate knowledge (86.3%) and communication barriers (84.7%) were the most reported difficulties. Generally, 77.3% of the residents described their confidence level in obtaining informed consent as good or adequate, and 33.9% were confident to discuss all key components of the informed consent. Residents' confidence level to independently obtain informed consent decreased with procedure complexity. Receiving formal training, senior level (postgraduate year (PGY) 4 and 5), and being frequently involved in obtaining informed consent correlated with increased confidence level. CONCLUSION Many residents incompletely disclosed key information upon obtaining informed consent and reported lacking confidence in their ability to perform the procedure in their daily practices. To improve patient care and residents' performance and overcome these difficulties and challenges, institutions should develop effective strategies to standardize the informed consent process, provide formal training for obtaining informed consent, and provide supervision for residents during obtention of informed consent.
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Affiliation(s)
- Abdulaziz Z Alomar
- Division of Arthroscopy & Sports Medicine, Department of Orthopaedic Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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