A Comparative Study of Patients’ Attitude Towards Informed Consent in Public and Private Hospitals

Abstract

Background: Patient's autonomy is an imperative issue in the health service field. It is a known fact that patient's awareness and understanding of legal and ethical issues related to the consent process is often limited. Adequate information before a surgical procedure is fundamental to give informed consent. Information should include a description of the benefits, risks and complications of the intended procedure as well the alternative treatment options. Objectives: The aim of this study was to compare patients in public and private hospitals of Kuwait as regards their understanding of legal implications, view about the scope, value and function of consent form during the clinical practice. Methods: A comparative descriptive cross-sectional survey was conducted in 6 public and 2 private hospitals from January to June 2016 in the state of Kuwait. A total of 910 patients aged 18 years old and above admitted to the surgery departments in the selected hospitals were invited. Structured self-administered questionnaires were distributed to the patients hospitalized in the selected departments of Kuwaiti hospitals. The questionnaire was pilot-tested prior to being finalized. Statistical analysis for the achieved data was done. Results: Of 910 patients, 805 (88.5%) completed the questionnaires. Patients in public hospitals were 584 (72.5%) while those in private hospitals were 221 (27.5%). Significantly higher proportion of patients in private hospitals were in the view that signing the consent form is a legal requirement (88.7%). Significantly more private sector patients agreed that signing the consent form means that all exactly are present in the consent form (91.0%), and the doctor cannot do anything different from what was on the form unless it is lifesaving (82.4%). More patients in private sector hospitals agreed about the statements that the consent form made it clear what was going to happen (79.6%) and the consent form gave the doctors control over what happened (72.9%). There were no statistical significant differences observed between patients in the two disciplines as regards their responses to the statements: the consent form is important (p = 0.167), the consent form made the patient aware of the risks of the operation (p = 0.520), the consent form made the patient wishes known (p = 0.393), the consent form prevents mix ups during the operation (p = 0.470), the consent form was just another piece of paper (p = 0.361), the patient just signed the consent form so he/she could have the operation (p = 0.053) and signing the consent form was mainly to protect the hospital (p = 0.049). Conclusion: Patients in public and private hospitals have limited knowledge of the legal implications of signing or not signing consent forms, indicates that consenting in its current form is not informed and should be reassessed in order to achieve patient autonomy. The policy and decision makers need to develop educational program towards inform consent.

Medicolegal Aspect of Consent

“…This study highlights the limited amount of knowledge people have got about oral or written consent or its legal implication, in a Pilot Project with Dental Hygiene Students to Assess Student Knowledge, Perceptions, and Attitudes conducted in 2017 by Tarp HC, Sanderson T, Fore ME, Nies MA supports this study, another comparative study in 2018 by Al Azmi SF, Almutairi BA, Al Jafar AM supports the finding of our study 12,13 . Some doctors believe that passing complete information about the complications of the procedure shall raise the level of anxiety among patients or their relatives which is not going to provide any benefit so they conceal the facts which should be known to the patient or his guardian, a study conducted in 2017 by Abd El-Latif AA, Abd-El-Atty B, Hossain MS, Rahman MA, Alamri A, Gupta BB and another study conducted by Parah SA, Ahad F, Sheikh JA, Bhat GM in 2017 supports our study 14,15 .…”

Surgical Consent in the Pediatric Age Group: Parental Perceptions Toward Legal Aspects of Informed Consent

“…The most important goal of informed consent is for patients to exercise their autonomy and provide consent after fully understanding all aspects of the intervention, including the risk in procedures such as surgeries. [ 10 11 12 13 14 ] Although the majority of parents in the current study agreed that consent is a legal obligation (92%) and that it is in place to protect patients’ rights (85.8%), two-thirds also believed that consent was mainly to protect doctors. This finding is in agreement with those found by Akkad et al .…”