Preoperative Informed Consent: Is It Truly Informed?

Article excerpt

Abstract

Background: Pre-operative informed consent is an important aspect of surgery, yet there has been no formal training regarding it in Pakistan. This study was done to assess the preoperative informed consent practice.

Methods: After taking informed permission, a questionnaire was filled in during an interview with 350 patients, who have undergone elective surgical procedures under routine practice conditions from July to October 2010. All the patients were asked a set of standard questions which related to the information they were provided before the operation as a part of standard informed consent practice.

Results: Most i.e. 307 (87.7%) patients were informed about their condition but very few 12 (3.4%) were briefed regarding complications. Only 17 (4.9%) patients said they knew about the risks and complications of proposed anesthesia. One hundred thirty-eight (39.4%) patients said that they were allowed to ask questions while giving consent. Most of the time 196 (56%) consent was taken one day before surgery but in few 2 (0.6%) instances it was taken on the morning of surgery and on operation table in some cases 3 (0.9%) as reported by patients. The consent form was signed by the patients themselves in only 204 (58.3%) cases and by their relatives in the rest. About half the number of patients 171 (48.9%) interviewed were satisfied from the information they received as informed consent process.

Conclusion: This study highlights the poor quality of patient knowledge about surgical procedures and the inadequate information provided.

Keywords: Informed consent, Surgical ethics, Operative risks, Pakistan

Introduction

Providing information is an important aspect of doctor-patient relationship. The need to provide relevant and comprehensible information to patients before invasive procedures is continuously increasing. Nowadays, informed consent has replaced the old paternalistic notion of ''the doctor knows best'', with a more mutual patientphysician relationship (1). Patients expect to be informed of the risk of surgical interventions (2). Pre-operative informed consent requires that the procedures are properly explained that the patient understands the procedures and their risks, and agrees to undergo them voluntarily (3). One reason for taking informed consent is that it provides assurance that patients and others are neither deceived nor coerced (4). Hence, the process of obtaining consent is as important as the contents.

Successful surgery depends on a relationship of trust between the patient and the doctor. To establish this, the patient's right to autonomy must be respected, even if their decision results in harm or death. Surgery is technically an assault, unless the patient has given permission for this to occur (5). However, despite these requirements; instances still arise in which patients claim to have been inadequately provided with the information necessary to make informed decisions (6).

In contrast to Western cultures, which adhere to more individually oriented philosophies, traditional Pakistani cultures place more value on the collective role of family in decision making. Due to this reason in the hospital practice of our region, most often patients are given inadequate information about their surgery before operation (7). Despite this general observation, there is limited research is available from our country about the usual practice of preoperative informed consent.

This study was designed to evaluate the current informed consent practice related to patients undergoing different surgical procedures in two large tertiary care teaching hospitals of Karachi.

Materials and Methods

The study was designed as an observational investigation, which dictated that no interference was to be made regarding the informed consent process to the patient. Study was carried out by using structured questionnaire-based interview technique by MF and ZM (both present simultaneously). …