Informed consent for elective and emergency surgery: questionnaire study

Abstract

Objectives To evaluate women's experience of giving consent to obstetric and gynaecological surgery and to examine differences between those undergoing elective and emergency procedures. Design A prospective questionnaire study. Setting A large teaching hospital. Population 1006 consecutive patients undergoing elective or emergency surgery in obstetrics and gynaecology. Methods Questionnaires were administered to women who had given consent to surgery following the introduction of national guidelines and consent form. Differences in responses between elective and emergency patients were assessed using frequencies, single and multivariable analyses. Main outcome measures Patients' experience and recall of the consent process, their overall satisfaction and their views on what is important for adequate consent. Results There were significant differences between patients undergoing elective or emergency surgery. Patients undergoing emergency surgery were less likely to have read (OR 0.22) or understood (OR 0.40) the consent form, and were more likely to report feeling frightened by signing it (OR 2.52). They were more likely to report they felt they had no choice about signing the consent form (OR 2.11), and that they would have signed regardless of its content (OR 3.14). Overall, significantly more patients undergoing elective (80%) or emergency (63%) surgery reported satisfaction with the consent process. Patients were more likely to report satisfaction if they read (OR 1.80) and agreed with (OR 3.49) the consent form, and if someone checked that they understood (OR 3.09). Conclusion Patients' needs may not be adequately addressed by current guidelines for consent to treatment, particularly in emergency circumstances. The introduction of more complex forms and procedures appears to conflict with patients' need for personal communication and advocacy. The implications on the ethical and legal standing of consent are considerable.

Informed consent for clinical treatment: Figure 1:

“…In a qualitative study involving women consenting to gynecological procedures, several patients described feeling compelled to sign the consent form despite their firm preference not to do so. 36,37 This finding is supported by related survey data showing that 30% of women (220/732) consenting to surgery did not think they had a choice about signing the consent form, 38 and that most of the women (88% [642/732]) perceived the form as "just another piece of paper" that satisfied administrative and legal requirements.…”

Informed consent for research in ICU obtained before ICU admission

“…This high rate is surprising. Indeed, patients before an elective surgery were shown to feel less under pressure and anxious and more likely to understand the informative leaflet than patients before an emergency surgery [14]. The most appropriate moment to obtain an informed consent for clinical research in ICU patients seemed to be before an elective ICU admission.…”

An audit of informed consent for cesarean section and instrumental delivery in a tertiary referral center in the United Kingdom

“…The difference between emergency and elective situations has been demonstrated in previous studies. A study of 734 patients undergoing elective or emergency surgery in obstetrics and gynecology was conducted by Akkad et al 8 Patients undergoing emergency surgery were less likely to have read or understood the consent form, and were more likely to report feeling frightened by signing it.…”