Surgical informed consent in obstetric and gynecologic surgeries: experience from a comprehensive teaching hospital in Southern Ethiopia

Abstract

BackgroundSurgical Informed Consent (SIC) has long been recognized as an important component of modern medicine. The ultimate goals of SIC are to improve clients’ understanding of the intended procedure, increase client satisfaction, maintain trust between clients and health providers, and ultimately minimize litigation issues related to surgical procedures. The purpose of the current study is to assess the comprehensiveness of the SIC process for women undergoing obstetric and gynecologic surgeries.MethodsA hospital-based cross-sectional study was undertaken at Hawassa University Comprehensive Specialized Hospital (HUCSH) in November and December, 2016. A total of 230 women who underwent obstetric and/or gynecologic surgeries were interviewed immediately after their hospital discharge to assess their experience of the SIC process. Thirteen components of SIC were used based on international recommendations, including the Royal College of Surgeon’s standards of informed consent practices for surgical procedures. Descriptive summaries are presented in tables and figures.ResultsForty percent of respondents were aged between 25 and 29 years. Nearly a quarter (22.6%) had no formal education. More than half (54.3%) of respondents had undergone an emergency surgical procedure. Only 18.4% of respondents reported that the surgeon performing the operation had offered SIC, while 36.6% of respondents could not recall who had offered SIC. All except one respondent provided written consent to undergo a surgical procedure. However, 8.3% of respondents received SIC service while already on the operation table for their procedure. Only 73.9% of respondents were informed about the availability (or lack thereof) of alternative treatment options. Additionally, a majority of respondents were not informed about the type of anesthesia to be used (88.3%) and related complications (87.4%). Only 54.2% of respondents reported that they had been offered at least six of the 13 SIC components used by the investigators.ConclusionsThere is gap in the provision of comprehensive and standardized pre-operative counseling for obstetric and gynecologic surgeries in the study hospital. This has a detrimental effect on the overall quality of care clients receive, specifically in terms of client expectations and information needs.Electronic supplementary materialThe online version of this article (10.1186/s12910-018-0293-2) contains supplementary material, which is available to authorized users.

Barriers to Obtaining Informed Consent on Shortterm Surgical Missions

“…Three studies recommended strategies to improve the process of obtaining informed consent. 26 – 28 The 4 recommended strategies were using visual aids such as videos, providing a context for the surgery based on the patient’s everyday life (eg, explaining how will the recovery affect a patient’s ability to work or how long they will need to stay away from their family), making the patient repeat the most important points, and pausing after each point.…”

“…Ochieng et al 23 found that 34% of the study participants, who were doctors from 3 Ugandan teaching hospitals, did not know the definition of informed consent. Teshome et al 28 found that doctors at a university hospital in Ethiopia did not include the majority of essential information required to obtain informed consent for obstetric and gynecological surgeries. On average, they only managed to consent patients for 4.5 out of 13 essential domains necessary to gain valid informed consent.…”

“…On average, they only managed to consent patients for 4.5 out of 13 essential domains necessary to gain valid informed consent. 28 Updating the medical school curriculum in LMICs to include more ethics teaching would provide a permanent solution to improving LMIC doctors’ understanding of the consent process and helping them create a more patient-centered approach to medicine. However, this solution would most likely need to be adopted at a governmental level.…”

Pre-post implementation survey of a multicomponent intervention to improve informed consent for caesarean section in Southern Malawi

“…Second, a sample size calculation was not performed due to absence of prevalence data on informed consent recollection in our setting or similar populations in the designing phase of the study. At the time of finalising this paper, such data are available 7 8. Our sampling was based on convenience and logistical possibilities.…”

“…Several reports have recognised weaknesses in the process of acquiring surgical informed consent for obstetric procedures, such as providing no explanation of the indication for surgery, procedure-related risks or the postoperative trajectory 7–16. Women may feel pressured into undergoing surgery when little information is provided or information is not understood 9 14.…”