1
|
Alqaydi A, Williams E, Nanji S, Zevin B. Optimizing the consent process for emergent laparoscopic cholecystectomy using an interactive digital education platform: a randomized control trial. Surg Endosc 2024; 38:2593-2601. [PMID: 38499783 DOI: 10.1007/s00464-024-10775-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/24/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Informed consent is essential for any surgery. The use of digital education platforms (DEPs) can enhance patient understanding of the consent discussion and is a method to standardize the consent process in elective, ambulatory settings. The use of DEP as an adjunct to standard verbal consent (SVC) has not been studied in an acute care setting. METHODS We conducted a prospective randomized control trial with patients presenting to the emergency department of a tertiary care hospital with acute biliary pathology requiring a laparoscopic cholecystectomy (LC) between August 2021 and April 2023. Participants were randomized 1:1 to receive either a DEP module with SVC or SVC alone. Baseline procedure-specific knowledge and self-reported understanding of risks and benefits of LC were collected using a questionnaire. Primary outcome was immediate post-intervention knowledge assessed using a 21-question multiple choice questionnaire. Secondary outcomes were delayed procedure-specific knowledge and participants' satisfaction with the consent discussion. RESULTS We recruited 79 participants and randomized them 1:1 into the intervention group (DEP + SVC, n = 40) and the control group (SVC, n = 39). Baseline demographics and baseline procedure-specific knowledge were similar between groups. The immediate post-intervention knowledge was significantly higher for participants in the intervention versus the control group with a Cohen's d effect size of 0.68 (85.2(10.6)% vs. 78.2(9.9)%; p = 0.004). Similarly, self-reported understanding of risks and benefits of LC was significantly greater for participants in the intervention versus the control group with a Cohen's effect size of 0.76 (68.5(16.4)% vs. 55.1(18.8)%; p = 0.001). For participants who completed the delayed post-intervention assessment (n = 29), there continued to be significantly higher retention of acquired knowledge in the intervention group with a Cohen's effect size of 0.61 (86.5(8.5)% vs. 79.8 (13.1)%; p = 0.024). There was no difference in participants' self-reported satisfaction with the consent discussion between groups (69.5(6.7)% vs. 67.2(7.7)%; p = 0.149). CONCLUSION The addition of digital education platform to standard verbal consent significantly improves patient's early and delayed understanding of risks and benefits of LC in an acute care setting.
Collapse
Affiliation(s)
- Anood Alqaydi
- Department of Surgery, Queen's University, Kingston, Canada
| | - Erin Williams
- Department of Surgery, Queen's University, Kingston, Canada
| | - Sulaiman Nanji
- Department of Surgery, Queen's University, Kingston, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Canada.
- Division of General Surgery, Department of Surgery, Queen's University, Burr 2, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| |
Collapse
|
2
|
Allen JW, Earp BD, Koplin J, Wilkinson D. Consent-GPT: is it ethical to delegate procedural consent to conversational AI? JOURNAL OF MEDICAL ETHICS 2024; 50:77-83. [PMID: 37898550 PMCID: PMC10850653 DOI: 10.1136/jme-2023-109347] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/03/2023] [Indexed: 10/30/2023]
Abstract
Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients' access to the relevant procedural information and therefore enhance informed decision-making.In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices.
Collapse
Affiliation(s)
- Jemima Winifred Allen
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Brian D Earp
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Julian Koplin
- Monash Bioethics Centre, Monash University, Melbourne, Victoria, Australia
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
- Newborn Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Donnelly P, Soares R, Eynon A, Grundy P, Durnford A. Animal products in neurosurgery - navigating informed consent. Br J Neurosurg 2023:1-4. [PMID: 37735919 DOI: 10.1080/02688697.2023.2256875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
Informed consent is an ethical and legal requirement integral to modern surgical practice. Clinicians have a duty to consider, disclose and discuss risks and concerns relevant to an individual patient. With medical advances there are now a significant number of animal-derived products and adjuncts available for use in modern neurosurgical practice, which may be relevant when consenting patients for specific procedures if such products are used. This paper highlights commonly used products in neurosurgery that contain animal-derived constituents with the aim of facilitating an informed discussion between the neurosurgeon and patient. We have reviewed the commonly used products in the centres of the authors and their commercial equivalents. The product information is taken from the manufacturer's instructions or the Federal Drug Administration documents regarding the product. Animal products commonly available to neurosurgeons can be broadly categorised into haemostatic agents, dural substitutes, dural sealants and bone cements. Many products contain a variety of animal (or human) derived products. In order to ensure informed consent and shared decision making, it is important to establish any relevant patient beliefs or views regarding the use of animal-derived products. Given the wide availability and use of neurosurgical adjuncts containing human or animal derived products, coupled with the heterogeneity within ethnic, religious, and social groups, each patient must be approached individually to ensure patient-specific concerns are identified and alternatives offered when appropriate.
Collapse
Affiliation(s)
- Patrick Donnelly
- Department of Neurosurgery, Mater Hospital Brisbane, South Brisbane, Queensland, Australia
| | - Rui Soares
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Andy Eynon
- University Hospital Southampton, Southampton, UK
| | - Paul Grundy
- University Hospital Southampton, Southampton, UK
| | | |
Collapse
|
4
|
Selvarajan A, Arulanandam B, Guadagno E, Poenaru D. Family risk communication preferences in pediatric surgery: A scoping review. J Pediatr Surg 2023; 58:891-901. [PMID: 36822973 DOI: 10.1016/j.jpedsurg.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Effective patient-surgeon communication is vital in pediatric surgical practice. However, family (including child) preferences for the format and content of risk communication information are largely unknown. In order to optimize the shared-decision making process, this scoping review explored the family-preferred methods for risk communication in pediatric surgery. METHODS A search was conducted in 7 databases from inception until June 2020 to identify family risk communication preferences in pediatric surgical patients, with language restricted to English and French. Two independent reviewers completed the screening in Rayyan software following PRISMA protocol. Included publications were reviewed for data extraction, analyzed, and assessed for risk of bias using standardized instruments. RESULTS A total of 6370 publications were retrieved, out of which 70 were included. Studies were predominantly from ENT (30.0%), general surgery (15.7%), and urology (11.4%). Family-preferred risk communication methods were classified as visual, verbal, technology-based, written, decision aids or other. Technological (32.4%) and written tools (29.7%) were most commonly chosen by families as their preferred risk communication methods. Written tools were frequently used in general surgery and urology, while technology-based tools were widely used in ENT. Most studies were cross-sectional and had a significant risk of bias. CONCLUSION Eliciting families' preferences for risk communication methods is critical for the implementation of shared decision-making. Different risk communication media appear to be preferred within specific surgical domains. To further improve shared-decision making in pediatric surgery, the development and usage of robust, validated risk communication tools are necessary. LEVEL OF EVIDENCE Level IV (Scoping Review).
Collapse
Affiliation(s)
- Arthega Selvarajan
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Brandon Arulanandam
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan Poenaru
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| |
Collapse
|
5
|
Deeb M, Alameddine D, Abi Radi Abou Jaoudeh R, Laoun W, Maamari J, Honeini R, Khouri A, Abou-Mrad F, Elia N, Abi-Gerges A. Knowledge about and attitudes toward medical informed consent: a Lebanese population survey. ETHICS & BEHAVIOR 2022. [DOI: 10.1080/10508422.2022.2153681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Mary Deeb
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Dana Alameddine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | | | - Widian Laoun
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Julian Maamari
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Rawan Honeini
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Alain Khouri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Fadi Abou-Mrad
- Faculty of Medical Sciences, Lebanese University, Lebanon; Memory Clinic, Division of Neurology, Saint Charles Hospital, Lebanon; Lebanon Memory Group for Clinical Research (GMRC-Liban), Lebanon
| | - Nassib Elia
- Faculty of Law, Sagesse University, Lebanon
- Judicial Studies Institute, Lebanese Ministry of Justice, Beirut, Lebanon
| | - Aniella Abi-Gerges
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| |
Collapse
|
6
|
Understanding the effectiveness of consent processes and conversations in pediatric surgery: A systematic-scoping review. J Pediatr Surg 2022; 57:834-844. [PMID: 36031429 DOI: 10.1016/j.jpedsurg.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The consent conversation in pediatric surgery is an essential part of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, other healthcare workers and the healthcare system. We reviewed the published literature on what key stakeholders perceive are the components of effective and ineffective consenting processes in pediatric surgery. METHODS A medical librarian searched seven databases to retrieve articles looking at the informed consenting process in surgical care for the pediatric population. Two independent reviewers screened all publications and categorized them by stakeholder perspectives (patient/family, surgical team, other healthcare team, and hospital administration or policy maker). General study characteristics, interventions to improve consent and features of effective and ineffective consent conversations were extracted. RESULTS 5079 titles and abstracts were screened, resulting in 88 full-text studies and 43 articles included in the final review. Most publications (51%) discussed informed consent only from the patient/family perspective, while 21% added surgeon's perspective. No study approached the consenting process from the perspective of all stakeholder groups. Effective consent components identified included use of multimedia, presence of multiple conversations prior to surgery, and individualized communication catered to unique family knowledge and needs. In contrast, ineffective conversations did not include a clear assessment of parental understanding, delivered too much information, and did not address parental anxiety. CONCLUSIONS The literature on the consenting process in pediatric surgery is narrow in stakeholder perspectives. Our findings highlight gaps in the literature and opportunities to improve the informed consent processes prior to pediatric surgery.
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Junior doctor experiences and challenges in obtaining surgical informed consent: A qualitative systematic review & meta-ethnography. J Surg Res 2021; 267:143-150. [PMID: 34147004 DOI: 10.1016/j.jss.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/20/2021] [Accepted: 05/07/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Surgical informed consent (SIC) to procedures is necessary to ensure patient autonomy is adequately respected. It is also necessary to protect doctors, and their institutions, from claims of negligence. While SIC is often acquired by senior consultants, it also commonly falls to the junior doctors on a team to ensure SIC is adequately acquired and documented. A growing body of literature suggests that junior doctors are not sufficiently educated about the legal and practical issues concerned with obtaining medical consent. This may open up this cohort, and their hospitals, to medico-legal liability. AIMS to provide a systematic review of the qualitative literature on junior doctors' experiences and challenges in consenting surgical patients and to synthesize evidence on this issue in order to guide policy-makers in the medicolegal and medical education spheres. METHODS a systematic review of qualitative literature was performed. Analysis of the literature was guided by Noblit and Hare's seven-step approach to meta-ethnography, with the final synthesis presented as a thematic analysis of the literature. CONCLUSION This research concludes that a significant proportion of SIC is likely to be acquired by junior doctors, many of whom are Post-Graduate Year (PGY) 1-2 and who lack adequate training and education. This cohort face challenges in assessing capacity, in ensuring adequate disclosure related to surgical procedures, and in adequately documenting consent. This may impact the validity of any SIC they acquire. Medical educators and policy-makers should be aware of these issues when creating policies impacting SIC, and when designing surgical education programs for medical students and junior doctors alike.
Collapse
|
10
|
Leclercq WK, Bonouvrie DS, Dohmen CE, Uittenbogaart M, Legemaate J, Stassen LP, van Dielen FM. Preoperative Education and Informed Consent in Young Adults Undergoing Bariatric Surgery: Patients' Perspectives on Current Practice. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Charlotte E.J.M. Dohmen
- Obesity Center Máxima, Máxima Medical Center, Eindhoven, The Netherlands
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Johan Legemaate
- Department of Public Health, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Laurents P.S. Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | |
Collapse
|
11
|
Jochum SB, Venkatramani M, Ritz EM, Favuzza J, Hayden DM, Saclarides TJ, Bhama AR. Surgical Residents' Perspective on Informed Consent-How Does It Compare With Attending Surgeons? J Surg Res 2020; 260:88-94. [PMID: 33333384 DOI: 10.1016/j.jss.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/27/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The informed consent discussion (ICD) is a compulsory element of clinical practice. Surgical residents are often tasked with obtaining informed consent, but formal instruction is not included in standard curricula. This study aims to examine attitudes of surgeons and residents concerning ICD. MATERIALS AND METHODS A survey regarding ICD was administered to residents and attending surgeons at an academic medical center with an Accreditation Council for Graduate Medical Education-accredited general surgery residency. RESULTS In total, 44 of 64 (68.75%) residents and 37 of 50 (72%) attending surgeons participated. Most residents felt comfortable consenting for elective (93%) and emergent (82%) cases, but attending surgeons were less comfortable with resident-led ICD (51% elective, 73% emergent). Resident comfort increased with postgraduate year (PGY) (PGY1 = 39%, PGY5 = 85%). A majority of participants (80% attending surgeons, 73% residents) believed resident ICD skills should be formally evaluated, and most residents in PGY1 (61%) requested formal instruction. High percentages of residents (86%) and attendings (100%) believed that ICD skills were best learned from direct observation of attending surgeons. CONCLUSIONS Resident comfort with ICD increases as residents advance through training. Residents acknowledge the importance of their participation in this process, and in particular, junior residents believe formal instruction is important. Attending surgeons are not universally comfortable with resident-led ICDs, particularly for elective surgeries. Efforts for improving ICD education including direct observation between attending surgeons and residents and formal evaluation may benefit the residency curriculum.
Collapse
Affiliation(s)
- Sarah B Jochum
- Rush University Medical Center, Department of Surgery, Chicago, Illinois
| | | | - Ethan M Ritz
- Rush University Medical Center, Bioinformatics and Biostatistics Core, Chicago, Illinois
| | - Joanne Favuzza
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois
| | - Dana M Hayden
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois
| | - Theodore J Saclarides
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois
| | - Anuradha R Bhama
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois.
| |
Collapse
|
12
|
Hladkowicz E, Yachnin D, Boland L, Wilson K, McKinnon A, Hawrysh K, Hawrysh T, Bell C, Atkinson K, van Walraven C, Taljaard M, Thavorn K, Stacey D, Yang H, Pysyk C, Moloo H, Manuel D, MacDonald D, Lavallée LT, Gagne S, Forster AJ, Bryson GL, McIsaac DI. Evaluation of a preoperative personalized risk communication tool: a prospective before-and-after study. Can J Anaesth 2020; 67:1749-1760. [PMID: 32929659 DOI: 10.1007/s12630-020-01809-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Patients want personalized information before surgery; most do not receive personalized risk estimates. Inadequate information contributes to poor experience and medicolegal complaints. We hypothesized that exposure to the Personalized Risk Evaluation and Decision Making in Preoperative Clinical Assessment (PREDICT) app, a personalized risk communication tool, would improve patient knowledge and satisfaction after anesthesiology consultations compared with standard care. METHODS We conducted a prospective clinical study (before-after design) and used patient-reported data to calculate personalized risks of morbidity, mortality, and expected length of stay using a locally calibrated National Surgical Quality Improvement Program risk calculator embedded in the PREDICT app. In the standard care (before) phase, the application's materials and output were not available to participants; in the PREDICT app (after) phase, personalized risks were communicated. Our primary outcome was knowledge score after the anesthesiology consultation. Secondary outcomes included patient satisfaction, anxiety, feasibility, and acceptability. RESULTS We included 183 participants (90 before; 93 after). Compared with standard care phase, the PREDICT app phase had higher post-consultation: knowledge of risks (14.3% higher; 95% confidence interval [CI], 6.5 to 22.0; P < 0.001) and satisfaction (0.8 points; 95% CI, 0.1 to 1.4; P = 0.03). Anxiety was unchanged (- 1.9%; 95% CI, - 4.2 to 0.5; P = 0.13). Acceptability was high for patients and anesthesiologists. CONCLUSION Exposure to a patient-facing, personalized risk communication app improved knowledge of personalized risk and increased satisfaction for adults before elective inpatient surgery. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03422133); registered 5 February 2018.
Collapse
Affiliation(s)
- Emily Hladkowicz
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,School of Rehabilitation Therapy, Queens' University, Kingston, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - David Yachnin
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Laura Boland
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Health Studies, Western University, London, ON, Canada
| | - Kumanan Wilson
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | | | - Cameron Bell
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Katherine Atkinson
- Department of Public Health Science, Karolinska Institute, Solna, Sweden
| | - Carl van Walraven
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Homer Yang
- Department of Anesthesia and Perioperative Medicine, Western University, London, ON, Canada
| | - Christopher Pysyk
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Husein Moloo
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Departments of Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Doug Manuel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - David MacDonald
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | - Luke T Lavallée
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Departments of Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Sylvain Gagne
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alan J Forster
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gregory L Bryson
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada. .,Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada. .,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
| |
Collapse
|
13
|
Hope WW, Walters K, Bools LM, Adams A, Hooks WB, Clancy TV. Evaluating Informed Consent Obtained by Surgical Residents. Am Surg 2020. [DOI: 10.1177/000313481408000530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- William W. Hope
- Department of Surgery South East Area Health Education Center Department of Surgery New Hanover Regional Medical Center Wilmington, North Carolina
| | - Kris Walters
- Department of Surgery South East Area Health Education Center Department of Surgery New Hanover Regional Medical Center Wilmington, North Carolina
| | - Lindsay M. Bools
- Department of Surgery South East Area Health Education Center Department of Surgery New Hanover Regional Medical Center Wilmington, North Carolina
| | - Ashley Adams
- Department of Surgery South East Area Health Education Center Department of Surgery New Hanover Regional Medical Center Wilmington, North Carolina
| | - W. Borden Hooks
- Department of Surgery South East Area Health Education Center Department of Surgery New Hanover Regional Medical Center Wilmington, North Carolina
| | - Thomas V. Clancy
- Department of Surgery South East Area Health Education Center Department of Surgery New Hanover Regional Medical Center Wilmington, North Carolina
| |
Collapse
|
14
|
Anderson TN, Aalami LR, Lee EW, Merrell SB, Sgroi MD, Lin DT, Lau JN. Perception and confidence of medical students in informed consent: A core EPA. Surgery 2020; 167:712-716. [DOI: 10.1016/j.surg.2019.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/17/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
|
15
|
Sutherland JM, Kurzawa Z, Karimuddin A, Duncan K, Liu G, Crump T. Wait lists and adult general surgery: is there a socioeconomic dimension in Canada? BMC Health Serv Res 2019; 19:161. [PMID: 30866903 PMCID: PMC6416854 DOI: 10.1186/s12913-019-3981-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 03/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about whether patients' socioeconomic status influences their access to elective general surgery in Canada. The purpose of this study was to assess the association between socioeconomic status and wait times for elective general surgery. METHODS Analysis of prospectively recruited participants' data. The setting was six hospitals in the Vancouver Coastal Health Authority, a geographically defined region that includes Vancouver, British Columbia, Canada. Participants had elective general surgery between October 2013 and April 2017, community dwelling, aged 19 years or older and could complete survey forms. The outcome measure was wait time, defined as the number of weeks between being registered for elective general surgery and surgery date. RESULTS One thousand three hundred twenty elective general surgery participants were included in the study. The response rate among eligible patients was 53%. Regression analyses found no statistically significant association between patients' wait time with SES, adjusting for health status, cancer status, surgical priority level, comorbidity burden and demographic characteristics. Participants with proven or suspected cancer status had shorter waits relative to participants waiting for surgery for benign conditions. Participants with at least one comorbidity tended to experience shorter waits of approximately 5 weeks (p < 0.01). Pre-operative pain or depression/anxiety were not associated with shorter wait times. CONCLUSIONS Although this study found no relationship between SES and surgical wait time for elective general surgeries in the study hospitals, patients in lower SES categories reported worse health when assigned to the surgical queue.
Collapse
Affiliation(s)
- Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201-2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
| | - Zuzanna Kurzawa
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201-2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Ahmer Karimuddin
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Katrina Duncan
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201-2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Trafford Crump
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
16
|
Veerman MM, van der Woude LA, Tellier MA, Legemaate J, Scheltinga MR, Stassen LPS, Leclercq WKG. A decade of litigation regarding surgical informed consent in the Netherlands. PATIENT EDUCATION AND COUNSELING 2019; 102:340-345. [PMID: 30173877 DOI: 10.1016/j.pec.2018.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 08/24/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE An inadequate surgical informed consent process (SIC) may result in a medical malpractice claim or medical disciplinary board (MDB) complaint. Aim of this study was to analyse characteristics of a decade of malpractice claims and MDB decisions regarding SIC in the Netherlands. METHODS A retrospective analysis of malpractice claims and MDB decisions concerning SIC disputes in four major surgical specialties was conducted based on company data from the largest medical malpractice insurance company and two public available online MDB databases. RESULTS A total of 11376 malpractice claims and 661 MDB complaints were filed between 2004-2013 and 676(6%) of these claims and 69(10%) of these complaints involved an alleged deficient SIC process. A random sample of 245(37%) claims and all MDB decisions were analysed. Reasons for filing a claim or complaint were insufficient counselling or recording of SIC elements. In 20% of lawsuits and 25% of claims the case resulted in favour of the complainant. CONCLUSION A substantial portion of malpractice claims and MDB decisions is related to a deficient SIC process. PRACTICE IMPLICATIONS Focusing on crucial SIC elements for patients may improve satisfaction and expectations and result in a lower risk for malpractice claims and MDB complaints.
Collapse
Affiliation(s)
- M M Veerman
- Department of Plastic Surgery, Rivierenland Hospital, Tiel, The Netherlands; Department of Surgery, Máxima Medisch Centrum, Eindhoven - Veldhoven, The Netherlands
| | - L A van der Woude
- Department of Plastic Surgery, Rivierenland Hospital, Tiel, The Netherlands; Department of Plastic Surgery, Isala klinieken, Zwolle, The Netherlands; Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Surgery, Máxima Medisch Centrum, Eindhoven - Veldhoven, The Netherlands
| | - M A Tellier
- Department of Plastic Surgery, Isala klinieken, Zwolle, The Netherlands
| | - J Legemaate
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - M R Scheltinga
- Department of Plastic Surgery, Rivierenland Hospital, Tiel, The Netherlands; Department of Plastic Surgery, Isala klinieken, Zwolle, The Netherlands; Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Surgery, Máxima Medisch Centrum, Eindhoven - Veldhoven, The Netherlands
| | - L P S Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - W K G Leclercq
- Department of Plastic Surgery, Rivierenland Hospital, Tiel, The Netherlands; Department of Plastic Surgery, Isala klinieken, Zwolle, The Netherlands; Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Surgery, Máxima Medisch Centrum, Eindhoven - Veldhoven, The Netherlands.
| |
Collapse
|
17
|
Teshome M, Wolde Z, Gedefaw A, Asefa A. Improving surgical informed consent in obstetric and gynaecologic surgeries in a teaching hospital in Ethiopia: A before and after study. BMJ Open 2019; 9:e023408. [PMID: 30679291 PMCID: PMC6347859 DOI: 10.1136/bmjopen-2018-023408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Even though surgical informed consent (SIC) has marked benefits, in many settings the information is not provided appropriately. In Ethiopia, minimal attention is given to SIC. This study assesses whether an intervention designed to improve SIC in obstetric and gynaecologic surgeries is associated with receipt of SIC components. DESIGN Pre-intervention and post-intervention surveys were conducted at Hawassa University Comprehensive Specialized Hospital among women who underwent obstetric or gynaecologic surgeries. The intervention consisted of a 3-day training on standard counselling for surgical procedures offered to health professionals. A total of 457 women were surveyed (230 pre-intervention, 227 post-intervention). An adjusted Poisson regression analysis was used to identify the association between the intervention and the number of SIC components received. RESULTS The majority of participants were 25-34 years of age in both the pre-intervention and post-intervention groups (p=0.66). 45.7% of the pre-intervention and 51.5% of the post-intervention survey participants underwent elective surgery (p=0.21). Additionally, 70.4% of pre-intervention survey participants received counselling immediately before surgery, compared with 62.4% of post-intervention participants (p<0.001). 5.7% of pre-intervention and 6.6% of post-intervention participants reported the belief that SIC consists entirely of signing on a piece of paper (p=0.66). After controlling for effects of potential confounders, the number of SIC components reported by post-intervention survey participants was 16% higher than what is received by pre-intervention ones (adjusted coefficient=1.16 (1.06-1.28)). Having elective versus emergency surgery was not associated with the number of components received by participants in either group (adjusted coefficient=0.98 (0.88-1.09)). CONCLUSION Training on the delivery of standard SIC is associated with receipt of a higher number of standard counselling components. However, there is a need to evaluate whether a one-time intervention leads to sustained improvement. A system-wide study of factors that promote SIC is required.
Collapse
Affiliation(s)
- Million Teshome
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zenebe Wolde
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abel Gedefaw
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
18
|
Does written informed consent adequately inform surgical patients? A cross sectional study. BMC Med Ethics 2019; 20:1. [PMID: 30616673 PMCID: PMC6323683 DOI: 10.1186/s12910-018-0340-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 12/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informed consent (IC) is an essential step in helping patients be aware of consequences of their treatment decisions. With surgery, it is vitally important for patients to understand the risks and benefits of the procedure and decide accordingly. We explored whether a written IC form was provided to patients; whether they read and signed it; whether they communicated orally with the physician; whether these communications influenced patient decisions. METHODS Adult postsurgical patients in nine general hospitals of Italy's Campania Region were interviewed via a structured questionnaire between the second and seventh day after the surgery at the end of the first surgical follow up visit. Physicians who were independent from the surgical team administered the questionnaire. RESULTS The written IC form was given to 84.5% of those interviewed. All recipients of the form signed it, either personally or through a delegate; however, 13.9% did not know/remember having done so; 51.8% said that they read it thoroughly. Of those who reported to have read it, 90.9% judged it to be clear. Of those receiving the written consent form, 52.0% had gotten it the day before the surgery at the earliest 41.1% received it some hours or immediately before the procedure. The written IC form was explained to 65.6% of the patients, and 93.9% of them received further oral information that deemed understandable. Most attention was given to the diagnosis and the type of surgical procedure, which was communicated respectively to 92.8 and 88.2% of the patients. Almost one in two patients believed that the information provided some emotional relief, while 23.2% experienced increased anxiety. Younger patients (age ≤ 60) and patients with higher levels of education were more likely to read the written IC form. CONCLUSIONS The written IC form is not sufficient in assuring patients and making them fully aware of choices they made for their health; pre-operative information that was delivered orally better served the patients' needs. To improve the quality of communication we suggest enhancing physicians' communication skills and for them to use structured conversation to ensure that individuals are completely informed before undergoing their procedures.
Collapse
|
19
|
Al-Taha MT, Butler MB, Hong P, Bezuhly M. The Effect of Written Information on Recall of Surgical Risks of Primary Cleft Palate Repair: A Randomized Controlled Study. Cleft Palate Craniofac J 2018; 56:806-813. [PMID: 30486659 DOI: 10.1177/1055665618813492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate parents' understanding of the risks of primary cleft palate surgery after counseling with and without the use of a written informational aid. DESIGN Prospective, randomized, single-blind trial. SETTING Academic tertiary care center. PARTICIPANTS Parents of children undergoing primary cleft palate surgery. INTERVENTIONS Parents were randomized to receive a standard informed consent discussion with or without provision of a written informational aid in the form of a pamphlet. MAIN OUTCOMES MEASURE Parents' recall of 9 specific surgical risks 3 weeks after informed consent discussion. RESULTS Forty parents enrolled in and completed the study (20 participants each in the control and intervention groups). There were no statistically significant differences between groups in terms of baseline demographics. The mean number of risks recalled were 3.7 (1.6) for the control group and 4.2 (1.9) for the intervention group (P = .37). The most commonly recalled risks were fistula formation and bleeding, while the least frequent were facial growth restriction and need for further surgery. No differences in risk recall were observed based on participant's gender, level of education, or income. CONCLUSION Parents of children undergoing primary cleft palate surgery recall less than 50% of counseled risks. The use of a written aid in the form of a pamphlet did not significantly improve recall in this sample. These results demonstrate that surgeons should implement additional measures to improve comprehension of surgical risks.
Collapse
Affiliation(s)
- Mona T Al-Taha
- 1 Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael B Butler
- 2 Department of Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Ontario, Canada
| | - Paul Hong
- 3 Division of Otolaryngology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- 4 Division of Plastic & Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
20
|
Mamoojee A, Alli A. Anaesthetists’ knowledge of South African Law pertaining to informed consent in an academic centre. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2018. [DOI: 10.1080/22201181.2018.1523861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Mamoojee
- Department of Anaesthesia, University of the Witwatersrand, Johannesburg, South Africa
| | - A Alli
- Department of Anaesthesia, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
21
|
Burger BB, Veerman MM, Tellier MA, Leclercq WKG, Mouës-Vink CM, Werker PMN. Insight in Information Provision Prior to Obtaining Surgical Informed Consent-by Audiotaping Outpatient Consultations. World J Surg 2018; 43:425-430. [PMID: 30267290 DOI: 10.1007/s00268-018-4804-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Literature suggests that patient-informing process prior to obtaining surgical informed consent (SIC) does not function well. This study aimed to provide insight into the current practice of SIC in the Netherlands. METHODS This is a prospective, observational, and multicenter study, conducted in one academic and two non-academic teaching hospitals in the Netherlands. Audio recordings were made during outpatient consultations with patients presenting with Dupuytren Disease. The recorded informing process was scored according to a checklist. Written documentation of the SIC process in the patient's chart was compared to these scored checklists. Time spent on SIC during the consultations was also recorded. RESULTS A total of 41 outpatient consultations were included in the study. Consultations were conducted by 25 plastic surgeons and their residents. Average time spent on SIC was 55.6% of the total consultation time. Considerable variation was observed concerning the amount and type of information given and discussed. In 59% of the consultations, discrepancies were observed between written documentation of consultations and audio recordings. Information on treatment risks, the postoperative period, and the operating surgeon was addressed the least. CONCLUSION Despite a relatively large part of the consultation time being spent on SIC, patients received scarce information concerning treatment risks, postoperative period, and who their operating surgeon would be. Discrepancies were observed between the written documentation of SIC and information recorded on the audio recordings. This occurred predominantly in one hospital that used a pre-made list of 'discussed information' in its digital patient chart.
Collapse
Affiliation(s)
- B B Burger
- Department of Plastic Surgery, Isala Hospital Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
| | - M M Veerman
- Department of Plastic Surgery, Hospital Rivierenland Tiel, President Kennedylaan 1, 4002 WP, Tiel, The Netherlands
| | - M A Tellier
- Department of Plastic Surgery, Isala Hospital Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - W K G Leclercq
- Department of Gastrointestinal and Oncologic Surgery, Maxima Medical Center Veldhoven, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - C M Mouës-Vink
- Department of Plastic Surgery, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - P M N Werker
- Department of Plastic Surgery, University of Groningen & University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| |
Collapse
|
22
|
Teshome M, Wolde Z, Gedefaw A, Tariku M, Asefa A. Surgical informed consent in obstetric and gynecologic surgeries: experience from a comprehensive teaching hospital in Southern Ethiopia. BMC Med Ethics 2018; 19:38. [PMID: 29793471 PMCID: PMC5968605 DOI: 10.1186/s12910-018-0293-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/17/2018] [Indexed: 11/12/2022] Open
Abstract
Background Surgical Informed Consent (SIC) has long been recognized as an important component of modern medicine. The ultimate goals of SIC are to improve clients’ understanding of the intended procedure, increase client satisfaction, maintain trust between clients and health providers, and ultimately minimize litigation issues related to surgical procedures. The purpose of the current study is to assess the comprehensiveness of the SIC process for women undergoing obstetric and gynecologic surgeries. Methods A hospital-based cross-sectional study was undertaken at Hawassa University Comprehensive Specialized Hospital (HUCSH) in November and December, 2016. A total of 230 women who underwent obstetric and/or gynecologic surgeries were interviewed immediately after their hospital discharge to assess their experience of the SIC process. Thirteen components of SIC were used based on international recommendations, including the Royal College of Surgeon’s standards of informed consent practices for surgical procedures. Descriptive summaries are presented in tables and figures. Results Forty percent of respondents were aged between 25 and 29 years. Nearly a quarter (22.6%) had no formal education. More than half (54.3%) of respondents had undergone an emergency surgical procedure. Only 18.4% of respondents reported that the surgeon performing the operation had offered SIC, while 36.6% of respondents could not recall who had offered SIC. All except one respondent provided written consent to undergo a surgical procedure. However, 8.3% of respondents received SIC service while already on the operation table for their procedure. Only 73.9% of respondents were informed about the availability (or lack thereof) of alternative treatment options. Additionally, a majority of respondents were not informed about the type of anesthesia to be used (88.3%) and related complications (87.4%). Only 54.2% of respondents reported that they had been offered at least six of the 13 SIC components used by the investigators. Conclusions There is gap in the provision of comprehensive and standardized pre-operative counseling for obstetric and gynecologic surgeries in the study hospital. This has a detrimental effect on the overall quality of care clients receive, specifically in terms of client expectations and information needs. Electronic supplementary material The online version of this article (10.1186/s12910-018-0293-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Million Teshome
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia.
| | - Zenebe Wolde
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
| | - Abel Gedefaw
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
| | - Mequanent Tariku
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
| | - Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O.Box 70, Hawassa, Ethiopia.,Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia
| |
Collapse
|
23
|
Shaker SH, Hosseini Kasnavieh SM, Amini M, Tahmasebi A, Soltani S. A Survey of Current Practice of Informed Consent in Iranian Hospitals. Hosp Top 2018; 96:69-74. [PMID: 29787344 DOI: 10.1080/00185868.2018.1451261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Informed consent is legal and ethical process which is considered as important issue in quality of patient's treatment. The aim of the current study was to assess current informed consent of patients admitted in Iranian selected Hospitals, 2016. MATERIALS AND METHODS This cross-sectional study was conducted on 2150 patients admitted in 11 public Hospitals. Data was collected using a dichotomous questionnaire with 30 questions. Statistical analysis was done using SPSS software (version 18). RESULTS The results shown that 46% of patients had medium perception about informed consent, 44% believed to get insufficient information and 66% claimed to have active participation in treatment process. The significant associations were found between some dimensions and important parameters: Understanding of information dimension and education level (p = 0.008), Participation (in decision-making) dimension and type of hospitalization (p = 0.01), and level of patients' information dimension with resident address (p = 0.027) and medical specialty (p < 0.001). CONCLUSION In our study the current informed consent of patients wasn't in desirable condition. The Necessary measures are required to achieve a level that the patients' informed consent convert to informed choices. Hospital healthcare team need to take proper actions such as give proper information, patient training, sufficient information and etc.
Collapse
Affiliation(s)
- Seyed Hosein Shaker
- a Department of Emergency Medicine , Iran University of Medical Sciences , Tehran , Iran
| | | | - Milad Amini
- b Trauma and Injury Research Center, Iran University of Medical Sciences , Tehran , Iran
| | - Ali Tahmasebi
- b Trauma and Injury Research Center, Iran University of Medical Sciences , Tehran , Iran
| | - Siamak Soltani
- c Department of Forensic Medicine , Iran University of Medical Sciences , Tehran , Iran
| |
Collapse
|
24
|
Koller SE, Moore RF, Goldberg MB, Zhang J, Yu D, Conklin CB, Milner RE, Goldberg AJ. An Informed Consent Program Enhances Surgery Resident Education. JOURNAL OF SURGICAL EDUCATION 2017; 74:906-913. [PMID: 28238705 DOI: 10.1016/j.jsurg.2017.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/18/2016] [Accepted: 02/03/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE First-year residents often obtain informed consent from patients. However, they typically receive no formal training in this area before residency. We wished to determine whether an educational program would improve residents' comfort with this process. DESIGN Our institution created an informed consent educational program, which included a didactic component, a role-play about informed consent, and a simulation exercise using standardized patients. Residents completed surveys before and after the intervention, and responses to survey questions were compared using the signed-rank test. SETTING This study took place at Temple University Hospital, a tertiary care institution in Philadelphia, PA. PARTICIPANTS First-year surgery and emergency medicine residents at Temple University Hospital in 2014 participated in this study. Thirty-two residents completed the preintervention survey and 27 residents completed the educational program and postintervention survey. RESULTS Only 37.5% had ever received formal training in informed consent before residency. After participating in the educational program, residents were significantly more confident that they could correctly describe the process of informed consent, properly fill out a procedure consent form, and properly obtain informed consent from a patient. Their comfort level in obtaining informed consent significantly increased. They found the educational program to be very effective in improving their knowledge and comfort level in obtaining informed consent. In all, 100% (N = 27) of residents said they would recommend the use of the program with other first-year residents. CONCLUSIONS Residents became more confident in their ability to obtain informed consent after participating in an educational program that included didactic, role-play, and patient simulation elements.
Collapse
Affiliation(s)
- Sarah E Koller
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
| | - Ryan F Moore
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Michael B Goldberg
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Jeanette Zhang
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Daohai Yu
- Department of Clinical Sciences, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Charles B Conklin
- Department of Risk Management, Temple University Hospital, Temple University Health System, Philadelphia, Pennsylvania
| | - Richard E Milner
- Temple University Lewis Katz School of Medicine, William Maul Measey Institute for Clinical Simulation and Patient Safety, Philadelphia, Pennsylvania
| | - Amy J Goldberg
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania; Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
25
|
Informing the process of consent for surgery: identification of key constructs and quality factors. J Surg Res 2017; 209:86-92. [DOI: 10.1016/j.jss.2016.09.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/21/2016] [Accepted: 09/27/2016] [Indexed: 11/17/2022]
|
26
|
Leclercq WKG, Sloot S, Keulers BJ, Houterman S, Legemaate J, Veerman M, Thomas L, Scheltinga MR. Challenging the knowledge base and skillset for providing surgical consent by orthopedic and plastic surgeons in the Netherlands: an identified area of improvement in patient safety. Patient Saf Surg 2016; 10:21. [PMID: 27790289 PMCID: PMC5075159 DOI: 10.1186/s13037-016-0110-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/13/2016] [Indexed: 11/25/2022] Open
Abstract
Background Successfully completing a surgical informed consent process is an important element of the preoperative consult. A previous study of Dutch general surgeons demonstrated that the implementation of SIC did not meet acceptable standards. However, the quality of the SIC process in the orthopedic surgical or plastic surgical arena is unknown. Methods Following ethical approval, an online survey investigating specifics of surgical informed consent was performed among members of the Dutch Scientific Association of Orthopedic Surgeons and the Dutch Society for Plastic Surgery. Results A total of 335 responses from a majority of departments of orthopedic (86 %) and plastic surgery (78 %) were eligible for analysis. Scores on knowledge were poor as only 50 % recognized the three basic elements of surgical informed consent (competence, exchange of information and consent). The orthopedic group used more tools in the surgical informed consent process, such as instruction movies and websites or specialized nursing staff, compared to plastic surgery (orthopedic: 31-50 % vs. plastic: 6-30 %, p = 0.05- < 0.001). In contrast, surgical informed consent forms were used more frequently by the plastic surgical group (orthopedic 21 % vs. plastic:42 % p < 0.001). Control of the efficacy of the surgical informed consent process was low, 36 % in both groups. One in every seven orthopedic or plastic surgeons was faced with an official surgical informed consent-related complaint in the previous five years. Conclusions Similar to general surgeons, Dutch orthopedic and plastic surgeons demonstrate poor knowledge and skills regarding surgical informed consent. Increased awareness, better training and use of modern tools including standard forms and online software programs will improve the SIC process and will optimize patient care. Electronic supplementary material The online version of this article (doi:10.1186/s13037-016-0110-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Wouter K G Leclercq
- Department of Surgery, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Sarah Sloot
- Department of Surgery, UMCG, Groningen, The Netherlands
| | - Bram J Keulers
- Department of Plastic Surgery, Bernhoven Hospital, Uden, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - Johan Legemaate
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Margot Veerman
- Department of plastic Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Leslie Thomas
- School of Information, University of South Florida, Tampa, USA
| | - Marc R Scheltinga
- Department of Surgery, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| |
Collapse
|
27
|
Olatosi JO, Adekola OO, Anaegbu NC, Adesida A, Rotimi MK. ANAESTHETISTS' ATTITUDES AND PRACTICE OF INFORMED CONSENT IN NIGERIA. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2016; 6:83-103. [PMID: 29181366 PMCID: PMC5667723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Informed consent is an integral part of a surgical and anaesthetic procedure, failure to obtain it may result in grave medico-legal implications. AIM To determine the attitudes of Nigerian anaesthetists to informed consent. METHODOLOGY The study population included physician anaesthetists who attended a continuous medical education programme in November 2015. The target was to cover over 50% of anaesthetists by convenience sampling. The responses to the questions were recorded and descriptive statistics were employed to calculate the various qualitative variables under study. RESULTS Fifty-six respondents were analysed, the majority were in the age group 31-40 years (37.5%), consultants were 51.79%, and males constituted 75%. The respondents agreed that the main purposes of informed consent included a need to improve the doctor/patient relationship in 36(64.29%), inform the patient about the desired benefits of the procedure in 32(57.14%), provide the doctor with greater protection against medical litigation in 32(57.14%), and to respect the patient's right of autonomy in 30(53.57%). The general consensus among the respondents was that the anaesthetist should explain to the patient what the procedure entails 40(71.43%), what the procedure aims to achieve and additional procedures that are likely to be necessary to the patient 41(73.21%). It was also agreed that there should be disclosure of all major risks/complications with incidence >1/20 in 29(51.79%) respondents, incidence >1/100 in 20(35.71%), incidence >1/1000, and incidence >1/10000 were 17(30.36%). The respondents who agreed that it is necessary to take consent before performing surgery or anaesthesia on patients and explained the procedure to patients were 48(85.71%). CONCLUSION We determined that informed consent was an integral part of a surgical procedure. which helped to improve doctor/patient relationship, respected the patient's right of autonomy and provided the surgeon and anaesthetists with greater protection against medical litigation. It is paramount to disclose all major risk and complications. However, few anaesthetists 19(33.93%) obtain informed consent from their patients before epidural labour analgesia.
Collapse
Affiliation(s)
- J O Olatosi
- Department of Anaesthesia, College of Medicine University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - O O Adekola
- Department of Anaesthesia, College of Medicine University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - N C Anaegbu
- Department of Anaesthesia, College of Medicine University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - A Adesida
- Department of Anaesthesia, College of Medicine University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - M K Rotimi
- Department of Anaesthesia, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| |
Collapse
|
28
|
Cho NL, Moalem J, Chen L, Lubitz CC, Moore FD, Ruan DT. Surgeons and patients disagree on the potential consequences from hypoparathyroidism. Endocr Pract 2016; 20:427-46. [PMID: 24325999 DOI: 10.4158/ep13321.or] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the hypothesis that surgeons and their patients underestimate the potential negative impact that permanent hypoparathyroidism has on quality of life (QOL). METHODS We used a modified SF-36 assessment tool to compare the perceptions of patients with permanent hypoparathyroidism to the perceptions of control subjects who were given a standardized preoperative statement about the complications of hypoparathyroidism. We also elicited the perceptions of endocrine surgeons regarding the QOL impacts of hypoparathyroidism using a subset of questions from the modified SF-36. RESULTS A total of 340 postsurgical patients with permanent hypoparathyroidism, 200 controls, and 102 surgeons participated in the study. Both surgeons and controls underestimated the negative impact of hypoparathyroidism on QOL when compared to patients living with permanent hypoparathyroidism. Forty-seven percent of hypoparathyroid patients believed that their health was "much worse" than before surgery, compared with 16% of surgeons (P<.001) and 7% of controls (P<.001). Postoperative hypoparathyroid patients also reported far more negative effects on QOL, from interference with social activities, paresthesias, muscle cramping, and medications than were anticipated by surgeons or controls (P<.05 for all comparisons). In each of the 8 dimensions of QOL, including physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain, and general health, hypoparathyroid patients reported a significantly lower mean score compared to the control group (P<.001 for all comparisons). CONCLUSION The impact of postoperative hypoparathyroidism on patient QOL is consistently and significantly underestimated by surgeons and subjects receiving surgical consultation.
Collapse
Affiliation(s)
- Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jacob Moalem
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Lily Chen
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carrie C Lubitz
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Francis D Moore
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel T Ruan
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
29
|
Vučemilo L, Milošević M, Dodig D, Grabušić B, Đapić B, Borovečki A. The quality of informed consent in Croatia-a cross-sectional study and instrument development. PATIENT EDUCATION AND COUNSELING 2016; 99:436-442. [PMID: 26343570 DOI: 10.1016/j.pec.2015.08.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/25/2015] [Accepted: 08/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the informed consent process implementation and quality in Croatia using a specially developed instrument. METHODS A cross-sectional questionnaire study was conducted in 300 patients (response rate 73%) from six hospitals in Croatia, along with psychometric evaluation of the questionnaire. RESULTS Signing the informed consent form was a formality for 64% of patients, 54% of patients did not give their written consent, and in 39% of cases physicians made treatment decisions by themselves. The overall informed consent process score was 4.06±0.60 (of 5.00). Physician-patient relationship score was 4.61±0.57, Verbal information 3.99±0.98, Decision making 3.94±0.75, and Written information 3.60±1.42. The overall Cronbach's alpha coefficient was 0.890. Significant correlations were found in relation to Physician-patient relationship and education levels (OR=0.43, 95% CI=0.18-0.99, p=0.048), and Verbal information and duration of health problems (OR=1.83, 95% CI=1.02-3.25, p=0.041). CONCLUSION The developed questionnaire is reliable and valid. The informed consent process quality in Croatia was reasonably high, although insufficient and inadequate written materials represent a weak spot that require enhancement. PRACTICE IMPLICATIONS The study contributes to the development of suitable measuring instrument for assessment of the informed consent process quality in clinical practice. The questionnaire could be of use in the hospital accreditation process.
Collapse
Affiliation(s)
- Luka Vučemilo
- Department of Otorhinolaryngology, University Hospital Merkur, Zagreb, Croatia.
| | - Milan Milošević
- University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia
| | - Doris Dodig
- Department of Radiology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Bruno Grabušić
- Department of Gynaecology and Obstetrics, General Hospital Zabok, Zabok, Croatia
| | - Biljana Đapić
- Department of Neurology, General Hospital Zadar, Zadar, Croatia
| | - Ana Borovečki
- University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia
| |
Collapse
|
30
|
Joolaee S, Faghanipour S, Hajibabaee F. The quality of obtaining surgical informed consent. Nurs Ethics 2015; 24:167-176. [DOI: 10.1177/0969733015584398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Informed consent goes beyond signing a form; it is a process of providing necessary information, helping patients make an informed decision, and actively participate in their treatment. Aim/objective: This study aimed to assess the quality of obtaining surgical informed consent in hospitals affiliated with Tehran University of Medical Sciences. Research design/participants/context: In a cross-sectional, descriptive-analytical study, 300 patients were chosen through stratified sampling from seven hospitals affiliated with Tehran University of Medical Sciences. Data were collected using a questionnaire developed by the researchers and analyzed using descriptive and analytical statistics on SPSS software. Ethical considerations: Ethical approval of this study was granted by Tehran University of Medical Sciences research ethics committee. Written informed consent for participation was obtained. The participants were reassured that their information will be used anonymously and their answers will not affect their treatment and care. Findings: The mean score of quality of acquisition of informed consent was 17.13 out of 35, indicating that the quality falls in the inappropriate category. The results indicate that 48% of the signatories do not even read the form before signing it. Among the 52% who did read the consent form, 61.3% mentioned varying degrees of incomprehensibility of the consent form and 94.2% mentioned the presence of incomprehensible technical, medical and legal vocabulary. Only 12% and 18% of respondents reported that they were not in hurry and they had no fear or anxiety, respectively, when signing the form. The quality of obtaining informed consent was higher in women, younger patients, patients with higher education, and those who had special surgeries. Discussion: This study shows a poor practice in obtaining surgical informed consent in Iran. It seems necessary to consider fundamental changes in the process of acquiring consent based on the temporal and local conditions of the patients.
Collapse
Affiliation(s)
- Soodabeh Joolaee
- Iran University of Medical Sciences, Iran; University of British Colombia, Canada
| | | | | |
Collapse
|
31
|
Nwosu A. The horror of wrong-site surgery continues: report of two cases in a regional trauma centre in Nigeria. Patient Saf Surg 2015; 9:6. [PMID: 25642288 PMCID: PMC4312470 DOI: 10.1186/s13037-014-0053-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 12/19/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Wrong- site surgeries are iatrogenic errors encountered in the course of surgical patient management. Despite the 'never do harm' pledge in the 'Hippocratic Oath' drafted in 5(th) century BC, man is after all human, with this limitation manifesting in the physician's art despite his best intention. Beyond the catastrophic consequences of wrong- site surgery on the patient and surgeon, and the opprobrium on the art of medicine, the incidents have come to be regarded as a quality-of-care indicator. Orthopaedic surgery is a specialty with a preponderance of this phenomenon and the attendant medico-legal issues relating to malpractice claims. Consequently the specialty had pioneered institutional initiatives at preventing these 'friendly-fires'. Awareness and implementation of these initiatives however remain low in many parts of the world, hampered by a culture of denial and shame. CASE PRESENTATION This report presents two cases of wrong-site surgery following trauma from road-traffic accident. The first case was a closed reduction of the 'wrong' dislocated hip in the trauma/emergency unit under the care of senior residents, while the second case was attempted wrong-site surgery on the right leg in a patient with fracture of the left tibia, in conjunction with bilateral femoral fracture and right radio-ulnar fracture; by an experienced Chief Consultant Orthopaedic Surgeon operating elective list. Both are orthopaedic cases, each with some trauma to both lower extremeties. Neither of the cases was formally mentioned anywhere in clinical discourse in the hospital, much less a formal report or audit. CONCLUSION There was no formal, institutionalized process to prevent wrong-site surgery in the health institution and this could have been largely responsible for these incidents. An open, mandatory process of reporting such incidents for relevant audit and awareness is necessary, as a mechanism for prevention rather than blame or punishment.
Collapse
|
32
|
Ashraf B, Tasnim N, Saaiq M, Zaman KU. An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC). Int J Health Policy Manag 2014; 3:315-21. [PMID: 25396207 DOI: 10.15171/ijhpm.2014.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/26/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The Surgical Informed Consent (SIC) is a comprehensive process that establishes an information-based agreement between the patient and his doctor to undertake a clearly outlined medical or surgical intervention. It is neither a casual formality nor a casually signed piece of paper. The present study was designed to audit the current knowledge and attitudes of doctors towards SIC at a tertiary care teaching hospital in Pakistan. METHODS This cross-sectional qualitative investigation was conducted under the auspices of the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over three months period. A 19-item questionnaire was employed for data collection. The participants were selected at random from the list of the surgeons maintained in the hospital and approached face-to-face with the help of a team of junior doctors detailed for questionnaire distribution among them. The target was to cover over 50% of these doctors by convenience sampling. RESULTS Out of 231 respondents, there were 32 seniors while 199 junior doctors, constituting a ratio of 1:6.22. The respondents variably responded to the questions regarding various attributes of the process of SIC. Overall, the junior doctors performed poorer compared to the seniors. CONCLUSION The knowledge and attitudes of our doctors particularly the junior ones, towards the SIC are less than ideal. This results in their failure to avail this golden opportunity of doctor-patient communication to guide their patients through a solidly informative and legally valid SIC. They are often unaware of the essential preconditions of the SIC; provide incomplete information to their patients; and quite often do not ensure direct involvement of their patients in the process. Additionally they lack an understanding of using interactive computer-based programs as well as the concept of nocebo effect of informed consent.
Collapse
Affiliation(s)
- Bushra Ashraf
- Department of Obstetrics and Gynecology, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Nasira Tasnim
- Department of Obstetrics and Gynecology, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Muhammad Saaiq
- Department of Plastic Surgery and Burns, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Khaleeq-Uz- Zaman
- Departments of Neurosurgery and Medical Education, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| |
Collapse
|