Perceived Quality of Informed Refusal Process: A Cross‐Sectional Study from Iranian Patients' Perspectives

Abstract

Patients have the right to refuse their treatment; however, this refusal should be informed. We evaluated the quality of the informed refusal process in Iranian hospitals from patients' viewpoints. To this end, we developed a questionnaire that covered four key aspects of the informed refusal process including; information disclosure, voluntariness, comprehension, and provider-patient relationship. A total of 284 patients who refused their treatment from 12 teaching hospitals in the Isfahan Province, Iran, were recruited and surveyed to produce a convenience sample. Patients' perceptions about the informed refusal process were scored and the mean scores of the four components were calculated. The findings showed that the practice of information disclosure (9.6 ± 6.4 out of 22 points) was perceived to be moderate, however, comprehension (2.3 ± 1.4 out of 4 points), voluntariness (8.7 ± 1.5 out of 12 points) and provider-patient relationship (10.2 ± 5.2 out of 16 points) were perceived to be relatively good. We found that patients, who refused their care before any treatment had commenced, reported a lower quality of information disclosure and voluntariness. Patients informed by nurses and those who had not had a previous related admission, reported lower scores for comprehension and relationship. In conclusion, the process of obtaining informed refusal was relatively satisfactory except for levels of information disclosure. To improve current practices, Iranian patients need to be better informed about; different treatment options, consequences of treatment refusal, costs of not continuing treatment and follow-ups after refusal. Developing more informative refusal forms is needed.

Nurses’ knowledge and performance of the patients’ bill of rights

“…Failure to observe this right has been consistently reported by several studies in Iran. 31,36,37 It is the patients’ right to refuse a treatment 9 and the medical team is required to provide enough information to patients and enable them to make a proper decision. As indicated by other studies, participation of the nurses in this regard helps the patients to make more informed decisions.…”

“…As indicated by other studies, participation of the nurses in this regard helps the patients to make more informed decisions. 9,10 Therefore, it is recommended that nurses help physicians in this regard.…”

A Survey of Current Practice of Informed Consent in Iranian Hospitals

“…Informed consent is effective only when patients have sufficient information about different treatment options (Faghanipour, Joolaee, and Sobhani 2014). Studies show that in some cases although patients long to be informed, they do not receive adequate information about their surgical procedure (Farzandipour, Sheikhtaheri, and Sadeqi Jabali 2015;.…”

Information Asymmetry between Physicians and Patients Undergoing Laparoscopic Cholecystectomy: Analysis of Patients’ Awareness Level

“…In developing countries, where education standards and literacy levels are comparably lower, information asymmetries are often observed between patients and healthcare professionals [15,16]. Moreover, studies conducted in Iran revealed that patients receive limited information about their medical condition and various treatment plans [2,17,18]. A study in this country indicated that 84.4%, 87.4%, and 86% of patients were not informed about other treatment options, bene ts of other treatment options, and complications of other treatment plans, respectively [18].…”