Knowledge and Practices of Obtaining Informed Consent for Medical Procedures among Specialist Physicians: Questionnaire Study in 6 Croatian Hospitals

Abstract

Aim To assess physicians' knowledge and practices for obtaining patients' informed consent to medical procedures.Methods An anonymous and voluntary survey of knowledge and practices for obtaining informed consent was conducted among 470 physicians (63% response rate) working in 6 hospitals: 93 specialists in anesthesiology, 166 in internal medicine, and 211 in surgery.Results Only 54% physicians were acquainted with the fact that the procedure for obtaining consent was regulated by the law. Internists and surgeons were better informed than anesthesiologists (P = 0.024). More than a half of respondents (66%) were familiar with the fact that a law on patient rights was passed in Croatia; there were no differences among different specialties (P = 0.638). Only 38% of the physicians were fully informed about the procedure of obtaining consent. Internists and surgeons provided detailed information to the patient in 33% of the cases and anesthesiologists in 16% of the cases (P < 0.050). Internists reported spending more time on informing the patient than anesthesiologists and surgeons (P < 0.001). There were no differences in knowledge and practices for obtaining informed consent between physicians working in university and those working in community hospitals (P ≥ 0.05 for all questions). ConclusionPhysicians in Croatia have no formal education on informed consent and implement the informed consent process in a rather formal manner, regardless of the type of hospital or medical specialty. Systemic approach at education and training at the national level is needed to improve the informed consent process. PUBLIC HEALTH doi: 10.3325/cmj.2009.50.567 PUBLIC HEALTH 568 Croat Med J. 2009 50: 567-74 www.cmj.hrInformed consent is a professional ethics issue emanating from the fiduciary responsibility of the physician to the patient. It is an integral component of the physician's fiduciary responsibility. In many countries informed consent for medical procedures is a standard procedure (1-9) for providing the patients with the information on diagnostic and treatment procedures, risks, complications, and alternative treatment options in non-emergency cases (5,9,10), thereby considerably improving the communication between physician and patient. A signed form is the evidence that their conversation led to a mutual understanding. However, the implementation of the informed consent process differs among countries because informing the patient and requiring the consent are still not regarded as a legal obligation of the physician (6).In the clinical setting, the term "informed consent" was developed in the USA in 1957. It was further developed in the Declaration of Helsinki in 1964, which established worldwide ethical principles for medical research involving human participants. In its current, 2008 version (11), the article 24 states: "In medical research involving competent human subjects, each potential subject must be adequately informed of the aims, methods, sources of funding, any possible conflicts of interest, insti...

Knowledge of medical law amongst doctors of internal diseases

“…As many as 95% of correct answers were noted when the respondents were asked the question on the necessity of obtaining the patient's consent to undergo higher-risk diagnostic procedures. The results are better than those obtained by Jukic et al [14]. They claim, only 38% of the doctors demonstrated a comprehensive knowledge on the method of obtaining a consent from patients.…”

“…Other authors claim that patients expect to be informed on po tential complications not more rarely than in 1/1000 cases (Newton-Howes [18], and Jamjoom [19] to training. In their study on doctors from Croatia they proved that only 38% had a comprehensive knowledge of issues connected with obtaining a consent to be provided with medical services [14]. Peters, mentioned before, states that only 51% of doctors from New Zealand had ever participated in any training on the necessity to ex press a consent by patients [13].…”

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

“…Our study identified considerable deficiencies in the current knowledge and attitudes of our doctors toward this very crucial area of doctor-patient communication. Surprisingly certain studies from institutions in the western countries such as the USA, Europe, Netherlands and New Zealand have also reported a lack of doctors' knowledge regarding the process of SIC (1,3,(7)(8)(9)(10). Less than ideal level of working knowledge and attitudes regarding SIC on part of our doctors indicates a case for their focused education regarding 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).…”

Adherence to informed consent standards in Shiraz hospitals: matrons’ perspective

“…Research in other countries has shown that despite the legal coercion to obtain an informed consent in an appropriate way, what actually happens cannot fulfill legal and professional requirements and the content of most of them did not meet accepted standards. It seems that systematic education of medical staff is needed to improve the process of obtaining informed consent (1,8). Taking a signature on the bottom of an informed consent form is not enough to say that this important part of medical ethics is applied in the hospital.…”