Patients' perception and actual practice of informed consent, privacy and confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore

Legal consciousness of psychiatric patients in Israeli hospitals: Awareness and satisfaction

The paper contributes to the literature on legal consciousness in medical settings by focusing on psychiatric patients' understanding of rights during hospitalization in Israeli psychiatric wards. It asks whether hospital personnel act as agents who promote patients' legal consciousness and whether patients are aware of their legal and social rights during hospitalization. The data for this study were derived from the Patient Experience Survey of Psychiatric Public Hospitals, a comprehensive survey conducted by the Israel Ministry of Health in 2017. The survey included two variables that were used to measure patients' legal consciousness: legal consciousness with hospitalization rights and legal consciousness with social rights. To predict legal consciousness and patient satisfaction, a logistic regression model was employed. The analysis reveals low rates of patients' awareness of hospitalization and social rights, varying between 55 and 66%, respectively. Variations in awareness are not strongly associated with patients' socioeconomic and demographic attributes or with hospital characteristics but are somewhat associated with hospitalization conditions. The data also reveal that awareness of legal rights (whether hospitalization rights or social rights) is likely to increase satisfaction with the hospitalization experience. The analysis underscores a significant finding. Patients' awareness of their legal rights during hospitalization is limited. Interestingly, this awareness is more influenced by the conditions of hospitalization than by the patients' socio-demographic attributes. This research also provides insights into the potential role of legal awareness in shaping patients' attitudes toward treatment and enhancing their satisfaction during hospitalization.

Perceptions and concerns of emergency medicine practitioners about artificial intelligence in emergency triage management during the pandemic: a national survey-based study

Objective

There have been continuous discussions over the ethics of using AI in healthcare. We sought to identify the ethical issues and viewpoints of Turkish emergency care doctors about the use of AI during epidemic triage.

Materials and methods

Ten emergency specialists were initially enlisted for this project, and their responses to open-ended questions about the ethical issues surrounding AI in the emergency room provided valuable information. A 15-question survey was created based on their input and was refined through a pilot test with 15 emergency specialty doctors. Following that, the updated survey was sent to emergency specialists via email, social media, and private email distribution.

Results

167 emergency medicine specialists participated in the study, with an average age of 38.22 years and 6.79 years of professional experience. The majority agreed that AI could benefit patients (54.50%) and healthcare professionals (70.06%) in emergency department triage during pandemics. Regarding responsibility, 63.47% believed in shared responsibility between emergency medicine specialists and AI manufacturers/programmers for complications. Additionally, 79.04% of participants agreed that the responsibility for complications in AI applications varies depending on the nature of the complication. Concerns about privacy were expressed by 20.36% regarding deep learning-based applications, while 61.68% believed that anonymity protected privacy. Additionally, 70.66% of participants believed that AI systems would be as sensitive as humans in terms of non-discrimination.

Conclusion

The potential advantages of deploying AI programs in emergency department triage during pandemics for patients and healthcare providers were acknowledged by emergency medicine doctors in Turkey. Nevertheless, they expressed notable ethical concerns related to the responsibility and accountability aspects of utilizing AI systems in this context.

Are we ready for a sustainable approach? A qualitative study of the readiness of the public health system to provide STI services to the key populations at risk of HIV in Bangladesh

INTRODUCTION

In Bangladesh, sexually transmitted infection (STI) services are available for all populations in public health facilities. However, STI services for key populations (KPs) at risk of HIV need specifically designed approaches that are predominantly administered to KPs through donor-supported service centers operated by non-government organizations (NGOs) and community-based organisations (CBOs). However, the steady decline in donor funding warrants a sustainable transition of STI services for the KPs into public health facilities. This article aimed to explore the service availability and readiness of public health facilities to provide STI services for the KPs.

METHODS

This qualitative study explored the service availability and readiness of public health facilities in three districts of Bangladesh by adapting the Service Availability and Readiness Assessment tool. We conducted 34 in-depth interviews,11 focus group discussions with KPs, and 29 key-informant interviews with healthcare providers, researchers, programme implementers and policy planners, in addition to series of direct observations at the public healthcare facilities. Data were analysed through thematic analysis, and categorised in relation to the WHO building blocks.

RESULTS

This study revealed that the public health system was generally not ready to serve the KPs' needs in terms of providing them with quality STI services. The 'service delivery' component, which is the most crucial facet of the public health system, was not ready to provide STI services to KPs. Findings also indicated that health workforce availability was limited in the primary and secondary healthcare layers but adequate in the tertiary layer, but needed to be oriented on providing culturally sensitised treatment. Counseling, an essential component of STI services, was neither ready nor available. However, health information systems and a few other components were partially ready, although this warrants systematic approaches to address these challenges.

CONCLUSION

The findings show that public health facilities are yet to be fully ready to render STI services to KPs, especially in terms of service delivery and human and health resources. Therefore, it is not only integral to mobilize communities towards the uptake of public health services, but health systems need to be prepared to cater to their needs.

Urban-rural inequalities and spatial arrangement of informed choice of family planning in Ethiopia: Further analysis of 2016 Ethiopian demographic health survey

BACKGROUND

Ethiopia has made satisfactory progress in improving maternal and child health over the past two decades. The introduction of family planning through informed choice is one of the main strategies to improve maternal and child health. However, this positive progress may have masked the significant urban-rural disparities in informed choice for family planning.

OBJECTIVE

To identify factor contributing to observed urban-rural disparities and to determine the spatial distribution of informed family planning choices in Ethiopia.

METHODS

The study used information from 3,511 women currently using contraceptives (rural-2685 and urban-826) as per recent Ethiopian demographic health survey cross-sectional data. Spatial and descriptive, bivariable, and multivariable logit-based decomposition analysis methods were used.

RESULTS

The spatial configuration of uninformed choice was clustered. The primary cluster (LLR = 34.8, p-value<0.001) was located at the southern portion of Amhara region that covers east & west Gojjam, south Gondar and south Wollo administrative zones. The magnitude of informed choice was 12 percent higher in urban residents compared to rural residents. Urban-rural gap was attributed to variations in characteristics (74%). Place of family planning offer i.e., private health facility, being aged between 35 and 49 years, and having visited to health facility in the last 1 year are found decrease the urban-rural gap of informed family planning choice by 15%, 9% and 5% respectively. Conversely, being aged between 25 and 34 years, being a listener to radio has increased the gap by 9% and 12% respectively.

CONCLUSION

The variables being private health facility visitors, being aged between 35 and 49 years and having visited health facilities in the last one year are found to increase the gap of informed family planning choices between urban and rural residents Besides, the spatial distribution of uninformed family planning choices is non-random.

Behind open doors: Patient privacy and the impact of design in primary health care, a qualitative study in Indonesia

Background

The importance and attention to patient privacy in recent decades have been directed mostly toward medical data protection in electronic means. Hence, other aspects of patients' privacy were overlooked, particularly in the primary health care (PHC) level. In the attempt of many countries, including Indonesia, to strive toward universal healthcare provision, a strong and accessible PHC is essential. This situation may create a tension in privacy provision where patients who need to disclose secrets may opt for other facilities, such as hospitals. This study aimed to describe and discuss patients' and doctors' perspectives and experiences about privacy in PHC in Indonesia, particularly since the universal coverage started.

Design and methods

We used in-depth interviews and observations to gather information. Inductive and thematic data analyses were conducted. We interviewed PHC users (n = 17), doctors (n = 16), other PHC staff (n = 7), and non-PHC users (n = 5) and observed the PHC activities.

Results

We found that privacy is imperative for both patients and doctors. Design and conditions in PHC, including consultation room doors open, separate rooms for treatment, and patients' symptoms asked by other staff were aspects that undermine privacy in PHC. Inadequate physical and informational privacy protection during a patient's visit has affected the quality of care negatively in ways that impede proper anamneses and physical examination.

Conclusion

Ensuring patients' and doctors' physical and informational privacy is essential to creating PHC as the primary source of care that responds to the privacy values of its users, but it has been overlooked. The PHC building designs and care provision guidelines should incorporate the privacy needs of patients and doctors.

Beliefs and Perceptions About Cancer Diagnosis and Treatment-Seeking and Decision-Making Behaviors Among Omani Patients with Cancer: A Single-Center Study

A cancer diagnosis is associated with anxiety and psychological distress. Cultural and societal factors greatly affect the complex process of coping mechanisms and decision making. Omani patients receiving cancer treatment at Sultan Qaboos University Hospital in Oman were interviewed about their perceptions regarding cancer, treatment, outcome, and decision making. Out of a total of 360 approached, 216 patients consented. The median age was 42 years. The results showed that 60.6% of patients considered cancer diagnosis as a test from God, 13.9% considered it as a result of an evil eye, 40% believed prayers treat cancer. Fifty-six percent of participants wanted to make treatment decisions themselves, while 2.3% preferred their family to make decisions. Our findings suggest that perceptions about cancer in Oman are specific and are associated with religion and sociocultural background.

Experience of Indonesian medical students of ethical issues during their clinical clerkship in a rural setting

Although ethics is an essential part of medical education, little attention has been paid to ethics education during the clerkship phase, where medical students observe how physicians make decisions regarding various ethical problems. Specific nuances and cultural contexts such as working in a rural setting can determine ethical issues raised. This phenomenology study aimed to explore ethical issues experienced by Indonesian students during clinical clerkship in a rural setting. In-depth interviews were used to explore students’ experiences. Participants were ten students, selected on gender and clerkship year variations. Data saturation was reached after eight interviews, followed by two additional interviews. Thematic analysis was used in this study, and trustworthiness was ensured through data and investigator triangulation, member checking, and audit trail.

Three main themes found in this study were limited facilities and resources, healthcare financing and consent issues, as well as unprofessional behavior of healthcare providers. Many ethical issues related to substandard care were associated to limited resources and complexities within the healthcare system in the rural setting. Early exposure to recurrent ethical problems in healthcare can help students prepare for their future career as a physician in a rural setting.

Perceptions and practices regarding the process of obtaining informed consent from surgical patients at a tertiary care hospital

BACKGROUND

Proper informed consent is essential for patients to have sound knowledge about the indication, risks, and benefits of a proposed surgical procedure. The study aim was to assess the perceptions of postoperative patients about the informed consent process and identify various influential factors in a tertiary care hospital.

METHODS

A cross-sectional study was conducted from February to August 2018 at a tertiary care hospital in Lahore, Pakistan. A validated questionnaire was used to conduct interviews of 101 patients planning to undergo elective surgery after fulfilling all ethical considerations. A purposive sampling technique was employed to enroll and the data analysis was performed by using SPSS version 23.

RESULTS

Out of total 101 patients, 50 (49.5%) of them were males and the mean age of total sample was 36.98 ± 14.23 years. The majority 92 (91.1%) considered informed consent to be important and that it did not influence their surgical decision 85 (84.2%). Consent was obtained by the consulting surgeon from 41 (40.6%) patients and by the residents/house officer from 60 (59.4%) patients. Fifteen (14.8%) patients signed the consent form themselves, and 86 (85.1%) relatives of patients signed. Ninety-eight (97.0) patients were told about indications of the surgery, and 54 (53.5%) were told about possible complications. Seventy-five (74.3%) patients were informed about alternatives to surgery. Significant reasons for not signing were language (p = 0.03), educational status (p = 0.002), and not being informed by relatives before signing (p = 0.02).

CONCLUSION

The patients had adequate knowledge about the process of informed consent and considered it important. Factors identified as barriers to signing the consent form by the patients themselves included language, better educational status, and not being asked by relatives. It is imperative to involve the patients in the process of consent, especially in signing by them or in their presence by their surrogate.

Comparison of the importance and observance of the patient's bill of rights from the perspectives of patients and personnel of hospitals in Kerman

Patients' rights are among the most important criteria for evaluating the quality of health services. The current study aimed to determine the importance and observance of the patient's bill of rights. This cross-sectional study was done in Kerman, Iran. The research samples were 217 patients and 204 personnel. The data collection tool was a researcher-made questionnaire in the scope of the patient's bill of rights, and data were analyzed by SPSS 15. The results showed a significant difference between patients and the personnel on the subject of the patient's bill of rights and most of its dimensions (P < 0.01). However, no significant difference was found between their views on the observance of the patient's bill of rights and its dimensions. Also, 35.9% of patients as well as 25% of personnel considered the observance of patients' rights unfavorable. The participants were aware of the importance of the patient's bill of rights. It is necessary, however, to codify and approve the laws related to the rights of patients.

Diabetes patients’ perspectives on the patients’ rights: evidence from east of Iran

Purpose

The Iranian patients’ rights charter defines patient rights as a reflection of fundamental human rights in the field of medicine and incorporates all elements of patient rights accepted in international texts. The purpose of this paper is to study the way in which diabetes patients’ rights are being exercised in everyday hospital practice in Birjand, Iran.

Design/methodology/approach

A cross-sectional study design was used in 2014. The sample size was estimated 150 patients, out of which 108 diabetes patients completed questionnaire. The questionnaire of diabetes patients’ perspectives on the patients’ rights was used to collect data. The questionnaire consists of 22 questions. Data entry and analysis were carried out using SPSS software (version 22). Descriptive and inferential statistics were calculated with all survey items and total scores, as well as demographic data.

Findings

The response rate was 72 percent. Overall, the mean score percentage of diabetes patients’ perspectives on the patients’ rights was 74.04± 8.4. Furthermore, statistical significant differences were found among diabetes patients in relation to patients’ perspectives on the patients’ rights according to highest level of education (F=16.52, p=0.002), their habitat(t=3.49, p=0.001), age groups (F=18.70, p=0.0001) and the duration of the disease (F=5.16, p=0.007). The results showed that no statistically significant differences were observed among diabetes patients in relation to diabetes patients’ perspectives on the patients’ rights according to their gender (F=1.57, p=0.12) and marital status (F=1.56, p=0.09).

Originality/value

Clinicians can provide care based on patients’ rights, and their knowledge of patients’ rights needs to be evaluated. Educational courses, leaflets, booklets and posters can be helpful in this regard. In addition, professional organizations and the Ministry of Health need to be more sensitive to this issue.

Informed consent practice for obstetric and gynaecologic procedures: A patients' perspective from a developing country

OBJECTIVES

To assess the surgical informed consent (SIC) practices for obstetric and gynaecological (OB-GYN) procedures at different hospitals in Pakistan.

METHODS

Study was conducted in five hospitals (three public and two private) of Peshawar, Pakistan. A pretested structured tablet-based questionnaire was administered from October 2016 through January 2017 among post-op OB-GYN patients.

RESULTS

About 27% of the patients (significantly more in private hospitals, P = 0.001) did not remember a formal consent administration. Most patients (80%) felt they had no choice about signing the consent. About 65% (mostly in public as compared with private hospitals) mentioned that they would have signed it regardless of the specifics in it (P < 0.001). Patients had increased odds to recall consent if they felt empowered, odds ratio (OR) = 4.5; had an opportunity to ask questions, OR = 7.2; wanted more explanation, OR = 2.8; and had consent administered in their mother tongue, OR = 6.9.

DISCUSSION

Patients' recall of key elements of consent was low. The time spent with the patient for consenting was much shorter than recommended. The printed consent forms were mostly not available in patients' mother tongue.

CONCLUSIONS

Consent practice for OB-GYN procedures was suboptimal in studied hospitals. Patients' attitude toward informed consent practices largely reflected providers' focus on obtaining a legally valid signed consent as opposed to administering a consent that empowers patients to make an informed decision in the absence of any external pressure.

Exploring clinical communication in a teaching hospital in Ghana

Purpose

The purpose of this paper is to investigate the clinical communication using Tamale Teaching Hospital as a case.

Design/methodology/approach

The paper is based on the Reassure, Explain, Listen, Answer, Take Action and Express Appreciation (RELATE) model and the Four Habits models of Clinical Communication.

Findings

The results of the study indicate that leadership conducted staff meetings with some of the components of the RELATE model. These include staff meetings, employee rounding and communication/notice boards. The results of the study also suggest that much as some parts of the Four Habits model was used in provider–patient communication, certain aspects of the model were absent. The study identified some communication challenges including poor dissemination, lack of unity among some health workers, poor attendance in meetings and, with respect to patients, language barrier, patients’ reluctance to disclose their actual health problems to health providers, lack of privacy and lack of a friendly environment.

Practical implications

Providers, especially physicians, should be given training on the local languages in areas where they perform their services. Health service providers should receive as part of their learning in-depth training on the Four Habits model of Clinical Communication, especially the Medical Officers.

Originality/value

It is imperative to embrace evidence-based practices/models aimed at securing proper communication in all hospitals but most especially teaching hospitals.

Assessing informed consent practices during normal vaginal delivery and immediate postpartum care in tertiary-level hospitals of Bangladesh

INTRODUCTION

This study was conducted to assess the informed consent practices during normal vaginal delivery (NVD) process and immediate postpartum care in the tertiary-level hospitals of Bangladesh.

METHODS

A cross-sectional study was conducted at Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in November 2015. The study population and respondents were mothers who gave normal vaginal childbirth within the past 24 hours and received postpartum care in the study sites (N=190). The interview of every alternate mother from the patient register was conducted by researchers using a structured questionnaire. Descriptive analysis of findings was carried out using MS Excel 2013.

RESULTS

The study findings revealed the complete absence of informed consent practices during NVD and postpartum care in the tertiary-level hospitals in Bangladesh. Consent (not informed consent) was taken from 95% of the mothers before proceeding with the NVD process, 50–72% of examinations (except breast examination, 0%) and 8–72% of procedures during postpartum care. Choice and preferences of mothers for taking an alternative process/examination/procedure were absent in all cases.

CONCLUSIONS

The Respectful Maternity Care (RMC) Charter endorsed informed consent as one of the basic rights of child-bearing women. Absence of informed consent practices in the study sites indicates disrespect to maternity care and violation of this right. The Standard Clinical Management Protocols of Bangladesh also lacks clarification of this right. Improvement of the existing protocol, increased awareness and practices are essential to address protection of this right.

Role of the family in Treatment Decision-Making process for Omani women diagnosed with breast cancer

OBJECTIVE

There is limited number of studies from Arabic countries on the participation of family members in Treatment decision-making (TDM) process. The aim of this study is to evaluate the role of family members in the TDM process among adult Omani women diagnosed with breast cancer.

METHODS

A cross-sectional study has been conducted with women diagnosed with breast cancer and their nominated family members.

RESULTS

A total of 79 patients and their nominated family members participated. The family members who were most engaged in the TDM were more likely to be young, male, employed and first-degree relative. The following characteristics of patients associated with more family-controlled the TDM: being older (crude odds ratio [OR] = 7.71; 95% confidence interval [CI]: 2.28-22.20), no formal education (OR = 0.18; 95% CI: 0.54) and diagnosed at stage IV (OR = 6.55; 95% CI: 1.89-22.65). The family members who dominate communication with the oncologists were more likely to control the TDM (OR = 6.03; 95% CI: 1.78-20.42).

CONCLUSION

Several factors influence the TDM process including age, gender, employments status, educational level and capability of communication.

PRACTICE IMPLICATIONS

The TDM process is heavily involves family members. This should be taking in consideration by oncologists during counselling in order to reach the best treatment.

Adherence to confidentiality principles from the viewpoint of Iranian dental students: A multicenter study

INTRODUCTION

Confidentiality is a basic ethical principle appreciating human autonomy, relationships, and dignity and in medical research has a long history. In dental practice, it has the same importance as medical field. Therefore, providing patients with information about the confidentiality will promote their confidence in dental professionals and prevent legal conflicts. The present study sought to evaluate the knowledge and viewpoints of dental students about patient confidentiality.

METHODS AND MATERIALS

In this multicenter applied research, the participants were recruited from schools of dentistry of Isfahan, Tehran, Tabriz, Shiraz, and Mashhad Universities of Medical Sciences and Isfahan Islamic Azad University during 2013. Ultimately, data were collected randomly with a researcher-made questionnaire from 180 dental students of fifth-sixth-year. The collected data were entered into SPSS 20.0. Independent t-tests and one-way analysis of variance (ANOVA) were performed to analyze the data.

RESULT

Overall, 60.3% of the participating students were concerned about acquiring adequate knowledge on the concept of patient confidentiality and 59.0% felt obliged to participate in related educational courses. Most students (66.5%) were careful not to share patient information with their friends. According to one-way ANOVA, students of Tehran University of Medical Sciences scored significantly higher than other participants. However, no significant differences were detected between the students of other schools.

CONCLUSION

The confidentiality laws imposed by the Ministry of Health and Medical Education seem to adequate details, but needs more education for dentists. Also it should be accentuated, due to state of confidentiality in patients' rights guidline and courses on ethics should be tailored based on the specific subjects raised in each field of dentistry.

The Role of Patients' Families in Cancer Treatment Decision-Making: Perspectives among Eastern and Western families

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Patients' Awareness About Their Rights: A Study from Coastal South India

Respecting patients' rights is a fundamental aspect of providing quality healthcare. The present investigation attempts to explore the awareness among patients about their rights in a coastal township in India. A questionnaire-based cross-sectional study was carried out among 215 patients admitted to the wards of a tertiary care teaching hospital in Mangalore. Awareness among patients regarding their rights varied for various issues and ranged between 48.4 and 87.4 %. Awareness about patients' rights was independent of gender, socio-economic and educational status. Doctors were found to be the most common source of information for patient's about their rights in the study. Doctors must conform to the relevant legislations and involve patients in all aspects of healthcare. There is a need to increase awareness among patients about their rights to ensure informed decisions and better health care services.

Human dignity of patients with cardiovascular disease admitted to hospitals of Kerman, Iran, in 2015

The human dignity of patients with cardiovascular disease (CVD) is an important issue, because of patients' dependence upon caregivers, and because it impacts all aspects of their quality of life (QOL). Therefore, understanding and improving the status of dignity among these patients is of great importance. This study aimed to determine the status of dignity in patients with CVD admitted to cardiac intensive care units (CICUs) in Iran. This cross-sectional descriptive study was performed in 2015 on 200 patients admitted to the CICUs of hospitals affiliated to Kerman University of Medical Sciences, Iran. The participants were selected using random sampling method. Patients' understanding of dignity was assessed through the reliable and valid Persian version of the Patient Dignity Inventory (PDI). Patients who were able to read and write or speak Persian and were conscious were included in the study. Data were analyzed using descriptive statistics tests, independent t-test, and one-way ANOVA in SPSS software. The mean age of the study participants was 59.0 ± 17.0. The mean score of human dignity was 3.60 ± 1.39. The mean scores of the factors of loss of independence, emotional distress and uncertainty, changes in ability and mental image, and the loss of human dignity were 3.94 ± 1.06, 3.63 ± 1.37, 3.57 ± 1.20, and 3.30 ± 2.08, respectively. A significant statistical correlation was observed between human dignity and the demographic characteristics of gender and frequency of hospitalizations in a CICU and a significant difference between those who lived alone and those who lived with family was observed (P < 0.05). Patients hospitalized in CICUs experience numerous problems associated with human dignity in each of its four dimensions. It is recommended that a study be conducted to investigate the relationship between the human dignity of patients with CVD and their QOL, anxiety, and depression.

Nurses’ and patients’ perceptions of privacy protection behaviours and information provision

Background:

With increased attention to patient privacy and autonomy, privacy protection and information provision for patients are becoming increasingly important.

Objectives:

The aim of this study was to identify and analyse nurses’ and patients’ perceptions of the importance and performance of protecting patients’ privacy and providing them with relevant information.

Research design:

This study is a descriptive cross-sectional investigation. Participants and research context: Participants were 168 patients hospitalised in medical and surgical wards and 176 nurses who cared for them.

Ethical consideration:

This study was approved by the Chung-Ang University Bioethics Committee, and informed written consent was collected from all participants.

Findings:

Nurses’ recognition of the importance of protecting patients’ privacy and providing adequate information was higher compared to their actual performance, and the nurses’ level of performance was higher in comparison with the patients’ recognition of its importance.

Discussion:

Although a holistic approach to patient privacy protection and information provision is needed, the medical field has not embraced this model of care.

Conclusions:

These findings provide empirical data to create an ethical environment for the future, as considerable attention has been devoted to patients’ rights and medical institutions’ liability for providing explanations to patients.

REALIZATION OF INFORMED CONSENT AS ONE OF PATIENT'S RIGHTS: CURRENT SITUATION IN AZERBAIJAN

Azerbaijan is a country in which the law is based on democratic principles. The mentioned principles underlie the national health care law. Democratic values, such as respect for human rights and freedoms, human dignity, as well as universal bioethical principles that are widely implemented in the national law, create conditions for the implementation of the patient's rights. The basic law governing the doctor-patient relationship, Law on Protection of Health of Population in Azerbaijan, reflects the basic patients' rights and obligations of doctors and medical institutions. Informed consent, which is a key component of patient rights, is also reflected, however, to date, a significant drawback of the Azerbaijan medical legislation is described in the article in this field. For example, at the moment there is no single standardized informed consent form in the country's different medical institutions. Due to the absence of any legally approved standards for informed consent forms, public and private health care institutions individually develop such forms, which sometimes can differ significantly. At the moment, one of the important directions in the field of healthcare is its improvement in accordance with international standards. The research made it possible to make conclusions about the necessary measures to improve and unify the informed consent form. The authors also analyzed the main provisions of the medical law of Azerbaijan and identified the main trends of its further development.

To Share or Not to Share: Malaysian Healthcare Professionals' Views on Localized Prostate Cancer Treatment Decision Making Roles

Aim

To explore the views of Malaysian healthcare professionals (HCPs) on stakeholders’ decision making roles in localized prostate cancer (PCa) treatment.

Methods

Qualitative interviews and focus groups were conducted with HCPs treating PCa. Data was analysed using a thematic approach. Four in-depth interviews and three focus group discussions were conducted between December 2012 and March 2013 using a topic guide. Interviews were audio-recorded, transcribed verbatim, and analysed thematically.

Findings

The participants comprised private urologists (n = 4), government urologists (n = 6), urology trainees (n = 6), government policy maker (n = 1) and oncologists (n = 3). HCP perceptions of the roles of the three parties involved (HCPs, patients, family) included: HCP as the main decision maker, HCP as a guide to patients’ decision making, HCP as a facilitator to family involvement, patients as main decision maker and patient prefers HCP to decide. HCPs preferred to share the decision with patients due to equipoise between prostate treatment options. Family culture was important as family members often decided on the patient’s treatment due to Malaysia’s close-knit family culture.

Conclusions

A range of decision making roles were reported by HCPs. It is thus important that stakeholder roles are clarified during PCa treatment decisions. HCPs need to cultivate an awareness of sociocultural norms and family dynamics when supporting non-Western patients in making decisions about PCa.

Rights and duties policy implementation in Chile: health-care professionals' perceptions

Objective

To explore the perceptions of health professionals in an integrated network of public provision of health services regarding the implementation of the Law on Rights and Duties of People in Chile.

Method

Qualitative descriptive study. A stratified qualitative sample of 53 professionals from five low complexity centres and one from a high complexity centre, all part of the integrated network of health services in Valdivia, Los Rios Region, Chile, were selected according to the criteria of an overall saturation of the explored dimensions. The information was gathered through a semi‐structured, in‐depth interview carried out after signing the informed consent. Data were analysed using an inductive approach of content analysis.

Results

Three categories emerged from the interviews: conceptualization and knowledge, factors influencing the implementation and recommendations for strengthening the implementation, and seven subcategories. It was highlighted that health professionals in the health‐care network perceived difficulties in implementing the Law on rights and duties of patients. Among them were the lack of knowledge about the Law, poor exposure and a lack of resources for its implementation. They suggested adapting the infrastructure of the institution and offering training as recommendations to improve the implementation of the Law.

Conclusions

There are hindering factors for the implementation of the Law related to organizational and professional gaps in the institutions providing health care.

The effect of multimedia interventions on the informed consent process for cataract surgery in rural South India

Context:

The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers.

Aims:

We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts.

Settings and Design:

We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group.

Materials and Methods:

The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item “True/False/I don’t know” quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively.

Statistical Analysis Used:

Scores on the quiz were compared across groups and time-points using paired t-tests.

Results:

Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10^-6) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10^-16). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes.

Conclusion:

Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.

Enhancing international medical graduates' communication: the contribution of applied linguistics

CONTEXT

International medical graduates (IMGs) make up one-third of the Australian medical workforce. Those from non-English-language backgrounds can face cultural and communication barriers, yet linguistic support is variable and medical educators are often required to provide feedback on both medical and communication issues. However, some communication difficulties may be very specific to the experiences of IMGs as second language users.

OBJECTIVES

This interdisciplinary study combines perspectives from applied linguistics experts and clinical educators to address IMGs' difficulties from multiple dimensions and to enhance feedback quality.

METHODS

Five video-recorded patient encounters with five IMGs were collected at Launceston General Hospital. Three clinical educators gave quantitative and qualitative feedback using the Rating Instrument for Clinical Consulting Skills, and two applied linguistics experts analysed the data for language, pragmatic and communication difficulties. The comparison of the educators' language-related feedback with linguistic analyses of the same interactions facilitated the exploration of differences in the difficulties identified by the two expert groups.

RESULTS

Although the clinical educators were able to use their tacit intuitive understanding of communication issues to identify IMG difficulties, they less frequently addressed the underlying issues or suggested specific remedies in their feedback.

CONCLUSIONS

This pilot study illustrates the effectiveness of interdisciplinary collaboration in highlighting the specific discourse features contributing to IMG communication difficulties and thus assists educators in deconstructing their intuitive knowledge. The authors suggest that linguistic insights can therefore improve communications training by assisting educators to provide more targeted feedback.

Attitudes of medical students in Lahore, Pakistan towards the doctor-patient relationship

Background. A good doctor–patient relationship is the centre stone of modern medicine. Patients are getting increasingly aware about exercising their autonomy and thus modern medicine cannot deliver all its advances to the patients if a good doctor–patient relationship is not established. We initiated this study with the aim to assess the leaning of medical students, who are the future physicians, towards either a doctor-centered or a patient-centered care, and to explore the effects of personal attributes on care such as gender, academic year, etc.

Materials & Methods. A cross-sectional study was conducted between July and Sep 2013. CMH Lahore Medical and Dental College Ethical Review Committee approved the study questionnaire. The study population consisted of 1,181 medical students in years 1–5 from two medical colleges. The English version of Patient Practitioner Orientation Scale (PPOS) was used to assess attitudes of medical students towards doctor–patient relationship. PPOS yields a mean score range of 1–6, where 1 signifies tendency towards a doctor centered relationship and 6 signifies patient-centered relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by multiple regression.

Results. A total of 783 students formed the final sample (response rate = 92%). Mean PPOS score of the entire sample was 3.40 (± .49 S.D.). Mean sharing sub-scale score was 3.18 (± 0.62 S.D. Mean caring sub-scale score was 3.63 (± 0.56 S.D.). Characteristics associated with most patient-centered attitudes were advanced academic year, having a clinical rotation, foreign background and studying in a private college. Gender, having doctor parents, relationship and residence status had no bearing on the attitudes (p > 0.05).

Conclusion. Despite ongoing debate and the emphasis on a patient-centered curriculum, our study suggests that the current curriculum and its teachings are not producing the results they are designed to achieve. Students should be adequately exposed to the patients from the beginning of their medical education in clinical settings which are more sympathetic to a patient-centered care.

Ethical violations in the clinical setting: the hidden curriculum learning experience of Pakistani nurses

Background

The importance of the hidden curriculum is recognised as a practical training ground for the absorption of medical ethics by healthcare professionals. Pakistan’s healthcare sector is hampered by the exclusion of ethics from medical and nursing education curricula and the absence of monitoring of ethical violations in the clinical setting. Nurses have significant knowledge of the hidden curriculum taught during clinical practice, due to long working hours in the clinic and front-line interaction with patients and other practitioners.

Methods

The means of inquiry for this study was qualitative, with 20 interviews and four focus group discussions used to identify nurses’ clinical experiences of ethical violations. Content analysis was used to discover sub-categories of ethical violations, as perceived by nurses, within four pre-defined categories of nursing codes of ethics: 1) professional guidelines and integrity, 2) patient informed consent, 3) patient rights, and 4) co-worker coordination for competency, learning and patient safety.

Results

Ten sub-categories of ethical violations were found: nursing students being used as adjunct staff, nurses having to face frequent violence in the hospital setting, patient reluctance to receive treatment from nurses, the near-absence of consent taken from patients for most non-surgical medical procedures, the absence of patient consent taking for receiving treatment from student nurses, the practice of patient discrimination on the basis of a patient’s socio-demographic status, nurses withdrawing treatment out of fear for their safety, a non-learning culture and, finally, blame-shifting and non-reportage of errors.

Conclusion

Immediate and urgent attention is required to reduce ethical violations in the healthcare sector in Pakistan through collaborative efforts by the government, the healthcare sector, and ethics regulatory bodies. Also, changes in socio-cultural values in hospital organisation, public awareness of how to conveniently report ethical violations by practitioners and public perceptions of nurse identity are needed.

Medical professionalism across cultures: a challenge for medicine and medical education

BACKGROUND

The recognition of medical professionalism as a complex social construct makes context, geographical location and culture important considerations in any discussion of professional behaviour. Medical students, medical educators and practitioners are now much more on the move globally, exposing them to cultural and social attitudes, values and beliefs that may differ from their own traditional perceptions of professionalism.

AIMS AND METHODS

This paper uses the model of the intercultural development continuum and the concept of "cultural fit" to discuss what might transpire when a student, teacher or doctor is faced with a new cultural environment. Using our own experiences as medical educators working abroad and supported by evidence in the literature, we have developed four anecdotal scenarios to highlight some of the challenges that different cultural contexts bring to our current (Western) understanding of professionalism.

RESULTS AND CONCLUSIONS

The scenarios highlight some of the potentially different regional and/or cultural perspectives and nuances of professional behaviours, attitudes or values that many of us either take for granted or find difficult, depending on our training and socio-cultural upbringing. With this paper, we hope to start a long overdue conversation about global professionalism amongst medical educators, identify potential areas for research and highlight a need for medical schools to embrace a "global" approach to how professionalism is embedded in their curricula.

Association between awareness of patient rights and patient's education, seeing bill, and age: a cross-sectional study

Background:

Considering the controversial results of previous reports on awareness of bill of patients’ rights in different regions, as well as the fact that no report is available on the awareness of patients of their rights in teaching hospitals of Sari, we conducted the present study.

Materials and Methods:

This is a cross-sectional Study conducted in teaching hospitals of Sari in 2011. The study population consisted of 336 patients recruited from 4 hospitals affiliated with Mazandaran University of Medical Sciences in Sari, through calculating the selection quota of each hospital. Data were collected through face-to-face interview on discharge, using a two-section questionnaire based on the bill of patient rights and with verified reliability and validity. Data analysis was accomplished on SPSS soft- ware version 10.

Results:

55.4% of patients were women and 44.6% were men. The patients’ mean age was 40.93 ± 15.04 years and the mean length of stay was 4.6 ± 3.34 days. Most patients had elementary education (36%) or were illiterate (25%). The majority (63.4%) had not seen the bill of patients’ rights. 58.9% had poor knowledge, 12% had intermediate knowledge, and 29.1% had good knowledge. As for the articles of the bill, the poorest awareness correlated to the 9^th article (the right to participate or refrain from participating in research). We found a significant relationship between awareness of the bill, and the patient’s education, seeing the bill, and age (p<0.0005).

Conclusion:

The results of the present study indicate that patients are not sufficiently aware of their rights, and this problem requires comprehensive planning to be resolved.

Patients' perceived purpose of clinical informed consent: Mill's individual autonomy model is preferred

BACKGROUND

Although informed consent is an integral part of clinical practice, its current doctrine remains mostly a matter of law and mainstream ethics rather than empirical research. There are scarce empirical data on patients' perceived purpose of informed consent, which may include administrative routine/courtesy gesture, simple honest permission, informed permission, patient-clinician shared decision-making, and enabling patient's self decision-making. Different purposes require different processes.

METHODS

We surveyed 488 adults who were planning to undergo or had recently undergone written informed consent-requiring procedures. Perceptions of informed consent purpose (from norm and current practice perspectives) were explored by asking respondents to rank (1 = most reflective) 10 randomly-presented statements: "meaningless routine", "courtesy gesture" "litigation protection", "take away compensation rights", "inform patient', "make sure patient understand", "document patient's decision", "discover patient's preferences", "have shared decision", and "help patient decide".

RESULTS

Respondents' mean (SD) age was 38.3 (12.5); 50.4% were males, 56.8% had ≥ college education, and 37.3% had undergone a procedure. From the norm perspective, the least reflective statement was "meaningless routine" (ranked 1-3 by 2.6% of respondents) and the most reflective statements were "help patient decide", "make sure patient understand", and "inform patient" (ranked 1-3 by 65%, 60%, and 48% of respondents with median [25%,75%] ranking scores of 2 [1,5], 3 [2,4], and 4 [2,5], respectively). Compared to their counterparts, males and pre-procedure respondents ranked "help patient decide" better, whereas females and post-procedure respondents ranked "inform patient" better (p = 0.007 to p < 0.001). Age was associated with better ranking of "help patient decide" and "make sure patient understand" statements (p < 0.001 and p = 0.002, respectively), which were ranked 1-3 by only 46% and 42% of respondents from the current practice perspective (median ranking score 4 [2,6], p < 0.001 vs. norm perspective for both).

CONCLUSIONS

1) the informed consent process is important to patients, however, patients vary in their views of its purpose with the dominant view being enabling patients' self decision-making, 2) males, pre-procedure, and older patients more favor a self decision-making purpose, whereas females and post-procedure patients more favor an information disclosure purpose, and 3) more self decision-making and more effective information disclosure than is currently practiced are desired. An informed consent process consistent with Mill's individual autonomy model may be suitable for most patients.

Information disclosure in clinical informed consent: "reasonable" patient's perception of norm in high-context communication culture

Background

The current doctrine of informed consent for clinical care has been developed in cultures characterized by low-context communication and monitoring-style coping. There are scarce empirical data on patients’ norm perception of information disclosure in other cultures.

Methods

We surveyed 470 adults who were planning to undergo or had recently undergone a written informed consent-requiring procedure in a tertiary healthcare hospital in Saudi Arabia. Perceptions of norm and current practice were explored using a 5-point Likert scale (1 = strongly agree with disclosure) and 30 information items in 7 domains: practitioners’ details, benefits, risks, complications’ management, available alternatives, procedure’s description, and post-procedure’s issues.

Results

Respondents’ mean (SD) age was 38.4 (12.5); 50.2% were males, 57.2% had ≥ college education, and 37.9% had undergone a procedure. According to norm perception, strongly agree/agree responses ranged from 98.0% (major benefits) to 50.5% (assistant/trainee’s name). Overall, items related to benefits and post-procedure’s issues were ranked better (more agreeable) than items related to risks and available alternatives. Ranking scores were better in post-procedure respondents for 4 (13.3%) items (p < 0.001 to 0.001) and in males for 8 (26.7%) items (p = 0.008 to <0.001). Older age was associated with better ranking scores for 3 (10.0%) items and worse for one (p < 0.001 to 0.006). According to current practice perception, strongly agree/agree responses ranged from 93.3% (disclosure of procedure’s name) to 13.9% (lead practitioner’s training place), ranking scores were worse for all items compared to norm perception (p < 0.001), and post-procedure status, younger age, and lower educational level were associated with better ranking scores for 15 (50.0%), 12 (40.0%), and 4 (13.3%) items, respectively (p < 0.001 to 0.009).

Conclusions

1) even in an overall high-context communication culture, extensive and more information than is currently disclosed is perceived as norm, 2) the focus of the desired information is closer to benefits and post-procedure’s issues than risks and available alternatives, 3) male, post-procedure, and older patients are in favor of more information disclosure, 4) male, older, and more educated patients may be particularly dissatisfied with current information disclosure. The focus and extent of information disclosure for clinical informed consent may need to be adjusted if a “reasonable” patient’s standard is to be met.

Medical confidentiality and the competent patient

Confidentiality is both a fundamental principle of medical ethics and a legal obligation. In exceptional situations not covered by legal provisions, doctors may want to waive confidentiality against the wishes of the patient. Swiss law calls for an authority to rule on such cases. In the Canton of Geneva this authority is the Commission for Professional Confidentiality. This paper concerns 41 cases managed by this commission. The study shows that the majority of these requests to the Commission concern the reporting of patients who are not incompetent but need the protection of a legal guardianship. In rare cases, there is another interest higher than confidentiality: public order or functioning of justice. The Commission found that the measure requested was justified in the majority of cases brought before it. This study focuses on exceptional cases but it throws into relief the conflict between the principle of autonomy on the one hand and the need for patient protection and social justice on the other.

Patients' awareness of their rights: insight from a developing country

BACKGROUND

Considering the effect of human right observance on patients' satisfaction from the treatment process, in Iran the Patient Rights Charter (PRC) was developed by the Ministry of Health and Medical Education (MOHME) in 2001 and enforced to all hospitals across the country. The purpose of the current study was to evaluate patients' awareness of their rights based on PRC in two tertiary teaching hospitals affiliated with Shiraz University of Medical Sciences (SUMS) in Iran.

METHODS

Current study was a cross-sectional descriptive and analytical survey. The research sample consisted of 200 inpatients and data were gathered through questionnaires filled out during the interview. The rate of awareness of patients was measured on a Likert scale ranging from 1 to 4. Validity and reliability of the questionnaire were confirmed. Data were analysed by descriptive and analytical statistics.

RESULTS

In 30.5% of cases, the total awareness of patients was weak, in 59.4% was moderate, and in 10.1% of them was good. The most awareness was about trust and assurance to confidentiality of treatment team, and the least was about providing sufficient information about treatment options and their complications. There was a significant relationship between educational level and the place of residency with patients' awareness (P<0.001).

CONCLUSION

Total awareness of patients from their rights was medium. Although compared to similar studies this rate was not unsatisfactory, attempts should be made to improve it. Health care organizations are to deliver PRC to patients and make sure they have proper information about their rights. Assuring observance of patients' rights requires not only informing healthcare policy makers and providers, but also educating citizens about what they must expect from their governments and health care providers. This will consequently improve the quality of services. Establishment of Patient Right Committee for supervision and monitoring of informing and observance of patients' rights is also recommended.

Building an ethical environment improves patient privacy and satisfaction in the crowded emergency department: a quasi-experimental study

Background

To evaluate the effectiveness of a multifaceted intervention in improving emergency department (ED) patient privacy and satisfaction in the crowded ED setting.

Methods

A pre- and post-intervention study was conducted. A multifaceted intervention was implemented in a university-affiliated hospital ED. The intervention developed strategies to improve ED patient privacy and satisfaction, including redesigning the ED environment, process management, access control, and staff education and training, and encouraging ethics consultation. The effectiveness of the intervention was evaluated using patient surveys. Eligibility data were collected after the intervention and compared to data collected before the intervention. Differences in patient satisfaction and patient perception of privacy were adjusted for predefined covariates using multivariable ordinal logistic regression.

Results

Structured questionnaires were collected with 313 ED patients before the intervention and 341 ED patients after the intervention. There were no important covariate differences, except for treatment area, between the two groups. Significant improvements were observed in patient perception of “personal information overheard by others”, being “seen by irrelevant persons”, having “unintentionally heard inappropriate conversations from healthcare providers”, and experiencing “providers’ respect for my privacy”. There was significant improvement in patient overall perception of privacy and satisfaction. There were statistically significant correlations between the intervention and patient overall perception of privacy and satisfaction on multivariable analysis.

Conclusions

Significant improvements were achieved with an intervention. Patients perceived significantly more privacy and satisfaction in ED care after the intervention. We believe that these improvements were the result of major philosophical, administrative, and operational changes aimed at respecting both patient privacy and satisfaction.

Patients' attitudes towards privacy in a Nepalese public hospital: a cross-sectional survey

Background

Many people in western countries assume that privacy and confidentiality are features of most medical consultations. However, in many developing countries consultations take place in a public setting where privacy is extremely limited. This is often said to be culturally acceptable but there is little research to determine if this is true. This research sought to determine the attitudes of patients in eastern Nepal towards privacy in consultations. A structured survey was administered to a sample of patients attending an outpatients department in eastern Nepal. It asked patients about their attitudes towards physical privacy and confidentiality of information.

Findings

The majority of patients (58%) stated that they were not comfortable having other patients in the same room. A similar percentage (53%) did not want other patients to know their medical information but more patients were happy for nurses and other health staff to know (81%). Females and younger patients were more concerned to have privacy.

Conclusion

The results challenge the conventional beliefs about patients’ privacy concerns in Nepal. They suggest that consideration should be given to re-organising existing outpatient facilities and planning future facilities to enable more privacy. The study has implications for other countries where similar conditions prevail. There is a need for more comprehensive research exploring this issue.

Unsatisfied patient's rights: A survey on the views of patients, nurses and physicians

Neglecting patients' rights in a health care system can give rise to a challenging situation between health care providers and patients. The purpose of this study was to compare the views of patients as recipients of healthcare services and physicians and nurses, as healthcare providers, regarding the unsatisfied demands of different aspects of patients' rights in 3 hospitals representing three types of settings (teaching, private, and public). This was a cross-sectional descriptive analytical study. Data were gathered using a questionnaire which was filled out by an interviewer for the patients and self administered for nurses and physicians. The research venues were one general teaching hospital, one first class private hospital, and one non-teaching public hospital, and all 3 were in Tehran. The questionnaire consisted of some general questions about respondents' demographics, and 21 questions concerning the importance of patients' rights, and how well patients' rights were observed. Overall, 143 patients, 143 nurses (response rate: 61%) and 82 physicians (response rate: 27.5%) completed the questionnaire. The degrees of unsatisfied demands were different depending on the various views within each group regarding the degree of importance and observance of each right, which was measured by the Likert's scale ranging from 0.0 (no importance, no observance) to 10.0 (absolutely important, full observance). Concerning the non-normal distribution, the collected data were analyzed by non-parametric tests using the SPSS software (ver. 11.5). Results showed that the studied groups had significantly different views. The most prominent issue concerned patients' to make an informed decision, which was particularly unsatisfactory in the teaching hospital. The results of this research indicate that healthcare providers, especially physicians, need to be informed to show more respect for patients' rights in terms of access to clinical information and making decisions. The results demonstrated that there was a significant difference between the opinions of patients and health care providers regarding the extent of unsatisfied demands of patients' rights. According to the patients, the level of unsatisfied demands of these rights is far higher than that expressed by physicians.

The effect of a visual aid on the comprehension of cataract surgery in a rural, indigent South Indian population

PURPOSE

To determine whether a visual aid improves the understanding and retention of information presented during informed consent for rural, indigent patients presenting for cataract surgery.

MATERIALS AND METHODS

This was a randomized, unmasked, interventional study. We recruited patients who presented to the Hande Surgical Hospital in Chennai, India, for cataract surgery. Patients were randomized into two groups: verbal consent alone (group A) and verbal consent plus a poster (group B). Both groups completed an 11-question true/false quiz immediately before and after informed consent and one day after surgery.

RESULTS

A total of 60 patients were recruited for the study, with 30 randomly assigned to each group; 23 patients from group A and 17 from group B completed the study. Informed consent improved patient scores in both groups; however, group B had significantly higher mean scores on postoperative day 1 (7.4 vs 8.7, P = 0.005) and significantly greater improvement in mean scores from pre-informed consent to postoperative day 1 (1.3 vs 3.6, P = 0.002).

CONCLUSIONS

Informed consent improves patient understanding of cataract surgery. Using a visual aid during informed consent for cataract surgery improves understanding and retention of information more than verbal consent alone in a rural South Indian population.

CQ Sources/Bibliography

These CQ Sources were compiled by Bette Anton.