Informed consent practices for surgical care at university teaching hospitals: a case in a low resource setting

Abstract

BackgroundInformed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching Hospitals in a low resource setting.MethodsA cross-sectional study conducted at three university teaching hospitals in Uganda. Self-guided questionnaires were left at a central location in each of the surgical departments after verbally communicating to the surgeons of the intention of the study. Filled questionnaires were returned at the same location by the respondents for collection by the research team. In addition, 20 in-depth interviews were held with surgeons and a review of 384 patients’ record files for informed consent documentation was done.ResultsA total of 132 (62.1%) out of 214 questionnaires were completed and returned. Respondents were intern doctors, residents and specialists from General surgery, Orthopedic surgery, Ear, Nose and Throat, Ophthalmology, Dentistry, Obstetrics and Gynaecology departments. The average working experience of respondents was 4.8 years (SD 4.454, range 0–39 years). 48.8% of the respondents said they obtained consent all the time surgery is done while 51.2% did not obtain consent all the time. Many of the respondents indicated that informed consent was not obtained by the surgeon who operated the patient but was obtained either at admission or by nurses in the surgical units. The consent forms used in the hospitals were found to be inadequate and many times signed at admission before diagnosing the patient’s disease.ConclusionsInformed consent administration and documentation for surgical health care is still inadequate at University teaching hospitals in Uganda.

An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC)

“…The aim was to cover all fundamental aspects of the knowledge and relevant attitudes that surround the process of SIC and hence generate a representative data that could serve as a valid outcome variable. The questionnaire was prepared by consulting previously used and validated questionnaires employed by other researchers (3,(5)(6)(7)(8).…”

“…All this information must be disclosed by the operating surgeon himself to the patient to help him arrive at informed decision-making about his treatment. A well-defined care plan incorporating the surgeon's advice should be discussed and it must be ensured that the patient understands all this information (3)(4)(5)(6). The objective of the present study was to audit the current knowledge and attitudes of surgical doctors towards the SIC at a tertiary care teaching hospital in a Pakistan.…”

Ethical Conducts of Professors, Undergraduates and Graduate Students: The View of Dental School Patients

“…Table 4 shows tooth donations requested from the patients and the informed consent signed by them. be respected so he/she can make decisions that might affect their life (1,13,16,18).…”

“…The patient and his/her rights are being respected, as required by Resolution CNS 466/12 (11), since it is necessary to show all procedures, risks and benefits, which must be written in language that is accessible and understandable to the research subject (1,(13)(14)(15)(16)18). It should be noted that the person's autonomy should…”

“…However, it is important to emphasize that the research volunteer and the patient are separate and have different needs. Research subjects contribute to science interests voluntarily and patients need treatment (1,17).…”