International Journal of Health Policy and Management

International Journal of Health Policy and Management

An Audit of the Knowledge and Attitudes of Doctors towards Surgical Informed Consent (SIC)

Document Type : Original Article

Authors
Bushra Ashraf 1
Nasira Tasnim 1
Muhammad Saaiq 2
Khaleeq- Uz-Zaman 3
1 Department of Obstetrics and Gynecology, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
2 Department of Plastic Surgery and Burns, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
3 Departments of Neurosurgery and Medical Education, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
10.15171/ijhpm.2014.109
Abstract
Background
The Surgical Informed Consent (SIC) is a comprehensive process that establishes an informationbased 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
Keywords
Surgical Informed Consent (SIC)
Consent
Nocebo Effect of Informed Consent
Surgery
Subjects
  1. Leclercq WK, Keulers BJ, Scheltinga MR, Spauwen PH, van der Wilt GJ. A review of surgical informed consent: past, present, and future. A quest to help patients make better decisions.  World J Surg 2010; 34: 1406-15. doi: 10.1007/s00268-010-0542-0
  2. Saaiq M, Zaman KU. Casual consent to treatment: a neglected issue in our health care system.Ann Pak Inst  Med Sci 2006; 2: 207-12.
  3. Leclercq WK,  Keulers BJ,  Houterman S, Veerman M, Legemaate J,  Scheltinga MR. A survey of the current practice of the informed consent process in general surgery in the Netherlands. Patient Saf Surg 2013; 7: 4. doi: 10.1186/1754-9493-7-4
  4. Wheeler R. Consent in surgery. Ann R Coll Surg Engl 2006; 88: 261-4. doi:  10.1308/003588406X106315
  5. Ochieng J, Ibingira C, Buwembo W, Munabi I, Kiryowa H, Kitara D, et al. Informed consent practices for surgical care at university teaching hospitals; a case in a low resource setting. BMC Med Ethics 2014; 15: 40.   doi: 10.1186/1472-6939-15-40
  6. Ashraf B, Tasnim N, Saaiq M, Zaman KU. Informed consent for surgery: Do our current practices conform to the accepted standards? J Coll Physicians and Surg Pak 2014; 24: 775-7.
  7. Abed H, Rogers R, Helitzer D, Warner TD. Informed consent in gynecologic surgery. Am J Obstet Gynecol  2007; 197: 674-5. doi: 10.1016/j.ajog.2007.08.066
  8. Jukic M, Kvolik S, Kardum G, Kozina S, Tomic JA. Knowledge and practices of obtaining informed consent for medical procedures among specialist physicians: questionnaire study in  6  Croatian  hospitals. Croat Med J 2009; 50: 567-74. doi: 10.3325/cmj.2009.50.567
  9. Peters C. Consenting to medical treatment: legal requirements vs medical practice. Are healthcare providers exposing themselves to potential legal action?  N Z Med J  2009; 122: 50-9.
  10. Fisher-Jeffes L, Barton C, Finlay F. Clinicians’ knowledge of informed consent. J Med Ethics 2007; 33: 181-4.  doi: 10.1136/jme.2006.016758
  11. Steinemann S, Furoy D, Yost F, Furumoto N, Lam G, Murayama K. Marriage of professional and technical tasks: a strategy to improve obtaining informed consent. Am J Surg  2006; 191: 696-700.  doi: 10.1016/j.amjsurg.2006.02.003   
  12. Leeper-Majors K, Veale JR, Westbrook TS, Reed K. The effect of standardized patient feedback in teaching surgical residents informed consent: results of a pilot study. Curr Surg  2003; 60: 615-22.  doi: 10.1016/S0149-7944(03)00157-0
  13. Pleat JM, Dunkin CS, Davies CE. Prospective survey of factors affecting risk discussion during consent in a surgical specialty. Br J Surg 2004; 91: 1377-80.  doi: 10.1002/bjs.4590
  14. Angelos P, Darosa DA, Bentram D. Residents seeking informed consent: are they adequately knowledgeable? Curr Surg  2002; 59: 115-8.
  15. McGaughey I. Informed consent and knee arthroscopies: an evaluation of patient understanding and satisfaction. Knee 2004; 11: 237-42 doi: 10.1016/S0968-0160(03)00107-8
  16. Jukic M, Kozina S, Kardum G, Hogg R, Kvolik S. Physicians overestimate patient’s knowledge of the process of informed consent: a cross-sectional study. Med Glas 2011; 8: 39-45.  
  17. Chen AM, Leff DR, Simpson J, Chadwick SJ, McDonald PJ. Variations in consenting practice for laparoscopic cholecystectomy. Ann R Coll Surg Engl 2006; 88: 482-5. doi: 10.1308/003588406X114857
  18. Schildmann J, Cushing A, Doyal L, Vollmann J. Informed consent in clinical practice: pre-registration house officers’ knowledge, difficulties and the need for postgraduate training. Med Teach 2005; 27: 649-51. doi: 10.1080/01421590500138747
  19. Gaeta T, Torres R, Kotamraju R, Seidman C, Yarmush J. The need for emergency medicine resident training in informed consent for procedures. Acad Emerg Med 2007; 14: 785-9. doi: 10.1111/j.1553-2712.2007.tb02352.x
  20. Hutul OA, Carpenter RO, Tarpley JL, Lomis KD. Missed opportunities: a descriptive assessment of teaching and attitudes regarding communication skills in a surgical residency. Curr Surg 2006; 63: 401-9. doi: 10.1016/j.cursur.2006.06.016
  21. Bollschweiler E, Apitzsch J, Obliers R, Koerfer A, Monig SP, Metzger R, et al. Improving informed consent of surgical patients using a multimedia-based program? Results of a prospective randomized multicenter study of patients before cholecystectomy. Ann Surg 2008; 248: 205-11. doi: 10.1097/SLA.0b013e318180a3a7
  22. Eggers C, Obliers R, Koerfer A, Thomas W, Koehle K, Hoelscher AH, et al. A multimedia tool for the informed consent of patients prior to gastric banding. Obesity (Silver Spring) 2007; 15: 2866-73.   doi: 10.1038/oby.2007.340
  23. Keulers BJ, Scheltinga MR, Houterman S, van der Wilt GJ, Spauwen PH. Surgeons underestimate their patients’ desire for preoperative information. World J Surg 2008; 32: 964-70.   doi: 10.1007/s00268-008-9581-1
  24. de Vries EN, Eikens-Jansen MP, Hamersma AM, Smorenburg SM, Gouma DJ, Boermeester MA. Prevention of surgical malpractice claims by use of a surgical safety checklist. Ann Surg 2011; 253: 624-8.   doi: 10.1097/SLA.0b013e3182068880
  25. Betti S, Sironi A, Saino G, Ricci C, Bonavina L. Effect of the informed consent process on anxiety and comprehension of patients undergoing esophageal and gastrointestinal surgery. J Gastrointest Surg 2011; 15: 922-7.  doi: 10.1007/s11605-011-1517-7
  26. Temple WJ, Russell ML, Parson LL, Huber SM, Jones CA, Bankes J, et al.  Conservation surgery for breast cancer as the preferred choice: a prospective analysis. J Clin Oncol 2006; 24: 3367-73.doi: 10.1200/JCO.2005.02.7771
  27. Breemhaar B, Van den Borne HW.  Effects of education and support for surgical patients: the role of perceived control. Patient Educ Couns 1991; 18: 199-210.
  28. Hoermann S, Doering S, Richter R, Walter MH, Schussler G. Patients’ need for information before surgery. Psychother Psychosom Med Psychol 2001; 51: 56–61.  doi: 10.1055/s-2001-10754
  29. Ashraf B, Saaiq M, Zaman KU. Qualitative study of Nocebo Phenomenon (NP) involved in doctor-patient communication. Int J Health Policy Manag 2014; 3: 23-27. doi: 10.15171/ijhpm.2014.54
  30. Cohen S. The nocebo effect of informed consent. Bioethics 2014; 28: 147-54. doi: 10.1111/j.1467-8519.2012.01983.x
  31. Wells RE, Kaptchuk TJ. To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent. Am J Bioeth 2012; 12: 22-9.  doi: 10.1080/15265161.2011.652798
  32. Nejadsarvari N, Ebrahimi A. Different aspects of informed consent in aesthetic surgeries. World J Plast Surg 2014; 3: 81-6.
  33. Thorevska N, Tilluckdharyy L, Ticko S, Havasi A, Amoateng-Adjepong Y, Manthous CA. Informed consent for invasive medical procedures from the patient’s perspective. Conn Med 2004; 68: 101-5. 
  34. Fink AS, Prochazka AV, Henderson WG, Bartenfeld D, Nyirenda C, Webb A, et al.  Enhancement of surgical informed consent by addition of repeat back: a multicenter, randomized controlled clinical trial. Ann Surg 2010; 252: 27-36. doi: 10.1097/SLA.0b013e3181e3ec61
  35. Schenker Y, Fernandez A, Sudore R, Schillinger D. Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review. Med Decis Making 2011; 31: 151-73. doi: 10.1177/0272989X10364247
  36. Pesudovs K, Luscombe CK, Coster DJ. Recall from informed consent  counselling for cataract surgery. J law Med 2006; 13: 496-504.
  37. Fink AS, Prochazka AV, Henderson WG, Bartenfeld D, Nyirenda C, Webb A, et al. Predictors of comprehension during surgical informed consent. J Am Coll Surg 2010;  210: 919-26. doi: 10.1016/j.jamcollsurg.2010.02.049
  38. Brezis M, Israel S, Weinstein-Birenshtock A, Pogoda P, Sharon A,  Tauber R. Quality of informed consent for invasive procedures. Int J Qual health care 2008; 20: 352-7. doi: 10.1093/intqhc/mzn025
  39. Deyo RA, Cherkin DC, Weinstein J, Howe J, Ciol M, Mulley AG Jr.  Involving patients in clinical decisions: impact of an interactive  video program on use of back surgery. Med Care 2000; 38: 959-69.     doi: 10.1097/00005650-200009000-00009

 

  • Received Date 22 July 2014
  • Revised Date 25 October 2014
  • Accepted Date 26 October 2014
  • First Published Date 01 November 2014
  • Published Date 01 November 2014