ObjectiveInformed consent is central to ethical medical practice, but little is known about how the process takes place in clinical practice. Percutaneous coronary intervention (PCI) is a common revascularisation procedure. Studies report that patients overestimate benefits, forget the risks and are unaware of alternative treatments. The aim of this study was to describe PCI patients’ and cardiologists’ experiences of the informed consent process in acute care settings.Design/setting/participantsA qualitative study with a maximum variation sample of elective and acute PCI patients and cardiologists taking their consent, recruited from a district general hospital and tertiary centre. In-depth interviews were conducted, and consent discussions were audio recorded. Data collection, coding and theorising occurred simultaneously.FindingsForty-one (26 male) patients scheduled for elective (20) or urgent (21) PCI and 19 cardiologists (5 female) participated. Despite diversity in patients’ experiences of informed consent, elective and acute patients experienced a common four-stage process of consent. Most patients made the decision to have treatment at PCI referral and took a passive role in the discussions we recorded. They recognised cardiologists as experts, trusted the medical system to ‘fix’ their health problem and were unaware of their role in the informed consent process. Informed consent discussions functioned as a formal ‘event’,enabling cardiologists to check patients’ understanding and enabling patients to access treatment.ConclusionsThe configuration of services and patients’ perceptions of their role in informed consent underpin a mismatch between legal and ethical principles of informed consent and current practice. The variation in patients’ experiences of the current place of informed consent in service delivery represents a missed opportunity for cardiologists to work in decision-making partnerships with patients. In light of recent changes in the law, a new approach to informed consent is required.
Background: Percutaneous Coronary Intervention (PCI) is a common revascularisation technique. Serious complications are uncommon, but death is one of them. Seeking informed consent in advance of PCI is mandatory. Research shows that PCI patients have inaccurate perceptions of risks, benefits, and alternative treatments. Aim: To assess cardiologists' and patients' views about the informed consent process and anticipated treatment benefits. Methods: Two cross-sectional, anonymous surveys were distributed in England. An electronic version to a sample of cardiologists, and a paper based version to patients recruited from 10 centres. Results: A sample of 118 cardiologists and 326 patients completed the surveys. Cardiologists and patients shared similar views on the purpose of informed consent; however, over 40% of patients and over a third of cardiologists agreed with statements that patients do not understand, or remember, the information given to them. Patients placed less value than cardiologists upon the consent process and over 60% agreed that patients depended on their doctor to make the decision for them.Patients' and cardiologists views on the benefits of PCI were significantly different; notably, 60% of patients mistakenly believed PCI was curative. Conclusions: The PCI informed consent process requires improvement to ensure that patients are more involved and accurately understand treatment benefits to make an informed decision.Redesign of the patient pathway is recommended to allow protected time for health professionals to engage in discussions using evidence based approaches such as 'teach back' and decision support which improve patient comprehension.
Background Percutaneous Coronary Intervention (PCI) is the commonest invasive procedure in cardiology. Before treatment consent must be given. As part of this communication process patients receive information about the risks and benefits of PCI and alternative treatments. Published studies tell us that the amount and quality of the information received by patients undergoing PCI is variable; benefits are often overestimated, risks forgotten and alternative treatments not always considered. Very little is known about patients' preferences for PCI risk information. Aim: To describe patients' preferences for formation about PCI treatment risk as part of the informed consent process Methods: A cross-sectional survey was distributed to 350 participants treated with PCI across 10 PCI centres in England. Results Three hundred and twenty six participants completed the survey. Thirty percent of the sample reported needing help to understand written medical information. Fifty-one percent were treated with elective PCI, 75% were male, average age of 66.5 years. Recall and comprehension of PCI information given during the consent process was generally limited; 47% and 61% agreed that patients do not usually understand, or remember, the information given to them respectively. Eighty-eight percent of urgent PCI patients wanted to know about all possible risks compared to 90% of elective cases. Most participants (88% urgent and 94% elective) believed that PCI would reduce their risk of a future heart attack. Conclusion A significant proportion of PCI patients find it difficult to recall or understand information about treatment risks. It is recommended that patients are given health-related information designed to accommodate different health literacy levels in advance of their treatment. Acknowledgement/Funding National Institute for Health Research Research for Patient Benefit Programme Grant Reference Number PB-PG-0712-28089
The Nursing & Midwifery Council (2015) states that all registered nurses must 'practice in-line with best available evidence'. Whilst there are clinical guidelines that are used to inform clinical practice, these often apply to medical rather than nursing interventions. Accordingly nurses must develop their critical appraisal skills to enable them to evaluate the available published research and consider to what extent findings might inform their clinical practice. A starting point for this process is an understanding of the characteristics of qualitative research and the key concepts that can guide the appraisal of a qualitative study. This paper provides and overview of the key points and frameworks for consideration in appraising qualitative evidence. Explain why appraisal of qualitative research is necessary. Key words Define key concepts that guide the appraisal of qualitative research and apply these to a qualitative research study of your choice.
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