Quality of informed consent for invasive procedures

Brezis, Mayer; Israel, Sarah; Weinstein-Birenshtock, Avital; Pogoda, Pnina; Sharon, Ayelet; Tauber, Renana

doi:10.1093/intqhc/mzn025

Cited by 80 publications

(76 citation statements)

References 19 publications

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“…Recent studies indicate that the majority of surgical consent discussions fail to meet criteria for fully informed consent. 25,26 It may be that decision aids designed to convey risks and benefits of cardiac surgical intervention in frail patients, particularly with regard to increased rates of prolonged institutional care, hospital mortality, and reduced long-term survival, would afford a more fully informed, shared decisionmaking process. It is equally important that the providers of cardiac surgical care work to mitigate the risks faced by frail patients through modification of processes of care.…”

Section: Discussionmentioning

confidence: 99%

Frail Patients Are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery

et al. 2010

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Background-Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. Where elderly patients are increasingly referred for cardiac surgery, the prevalence of a frail group among these is also on the rise. We assessed frailty as a risk factor for adverse outcomes after cardiac surgery. Methods and Results-Functional measures of frailty and clinical data were collected prospectively for all cardiac surgery patients at a single center. Frailty was defined as any impairment in activities of daily living (Katz index), ambulation, or a documented history of dementia. Of 3826 patients, 157 (4.1%) were frail. Frail patients were older, were more likely to be female, and had risk factors for adverse surgical outcomes. By logistic regression, frailty was an independent predictor of in-hospital mortality (odds ratio 1.8, 95% CI 1.1 to 3.0), as well as institutional discharge (odds ratio 6.3, 95% CI 4.2 to 9.4).Frailty was an independent predictor of reduced midterm survival (hazard ratio 1.5, 95% CI 1.1 to 2.2). Conclusions-Frailty is a risk for postoperative complications and an independent predictor of in-hospital mortality, institutional discharge, and reduced midterm survival. Frailty screening improves risk assessment in cardiac surgery patients and may identify a subgroup of patients who may benefit from innovative processes of care. (Circulation. 2010;121:973-978.)

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Section: Discussionmentioning

confidence: 99%

Frail Patients Are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery

et al. 2010

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“…We wanted to have more robust comparison of the findings of our study with similar published literature from particularly the other developing countries in our neighborhoods, however we could not find any quality publications from these countries. In glaring contrast to this situation, the majority of studies published from the developed countries are more focused on patients' perspectives of the process of SIC, with a recent growing trend towards the use of multimedia in the process and their impact on the patient's understanding of the content of SIC (32)(33)(34)(35)(36)(37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

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

Ashraf

Tasnim

Saaiq

et al. 2014

Int J Health Policy Manag

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Background: The Surgical Informed Consent (SIC) is a comprehensive process that establishes an informationbased agreement between the patient and his doctor to undertake a clearly outlined medical or surgical intervention. It is neither a casual formality nor a casually signed piece of paper. The present study was designed to audit the current knowledge and attitudes of doctors towards SIC at a tertiary care teaching hospital in Pakistan. Methods: This cross-sectional qualitative investigation was conducted under the auspices of the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over three months period. A 19-item questionnaire was employed for data collection. The participants were selected at random from the list of the surgeons maintained in the hospital and approached face-to-face with the help of a team of junior doctors detailed for questionnaire distribution among them. The target was to cover over 50% of these doctors by convenience sampling. Results: Out of 231 respondents, there were 32 seniors while 199 junior doctors, constituting a ratio of 1:6.22. The respondents variably responded to the questions regarding various attributes of the process of SIC. Overall, the junior doctors performed poorer compared to the seniors. Conclusion:The knowledge and attitudes of our doctors particularly the junior ones, towards the SIC are less than ideal. This results in their failure to avail this golden opportunity of doctor-patient communication to guide their patients through a solidly informative and legally valid SIC. They are often unaware of the essential preconditions of the SIC; provide incomplete information to their patients; and quite often do not ensure direct involvement of their patients in the process. Additionally they lack an understanding of using interactive computer-based programs as well as the concept of nocebo effect of informed consent.

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“…It is important how a physician formulates the information presented to the patient, as it has been shown that patients often do not recollect all information provided by a physician (8), and the physicians often estimate that patients do not understand the obtained information on the health condition and possibilities of treatment (19). Nevertheless, the majority of physicians respect patients' autonomy and their decisions and requires the consent of relatives when the patient is not capable of reaching a decision (27).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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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...

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Quality of informed consent for invasive procedures

Cited by 80 publications

References 19 publications

Frail Patients Are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery

Frail Patients Are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery

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

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

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