Browsing by Author "Herath, H.M.C.J."
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Item Quality of informed consent as experienced by patients awaiting surgical intervention in a tertiay care setting in Sri Lanka(Sri Lanka Medical Association, 2018) Gunathunga, M.H.D.; Hansamali, M.M.P.; Hapuarachchi, H.S.M.; Herath, H.M.T.H.; Herath, H.M.C.J.; Chandratilake, M.N.INTRODUCTION AND OBJECTIVES: Informed consent is a basic ethical principle. The existing guidelines may not be fully operational in practice. The objective of this study was to identify the common lapses in obtaining informed context METHODS: A cross-sectional descriptive study was conducted in surgical wards of North-Colombo Teaching Hospital. A questionnaire was developed by observing 11 consent-taking encounters. 100 in-ward patients awaiting surgical interventions completed the questionnaire. RESULTS: We observed that the information regarding surgery is provided by different personnel along the process. The gap between information provision and consent taking appeared inadequate for patients to take a well thought-out decision. In most instances, consenting was given by signing/thumb-printing a statement prescribed by the intern house officer. Disturbances to the process of doctor-patient conversation were also observed and privacy was a concern as the setting for doctor-patient conversation was not in an acceptably private space. According to patients, information provision (48% in the clinic; 43% of the time by senior doctors) and expressing (100% in the ward; 86% of the time by most junior doctors and 10% by nurses) have happened as two disjointed processes. Common lapses identified by patients were: alternative treatment options were not explained (85%); a tendency not to discuss risks (50%); confinement to verbal explanation (87%); and not requesting patients to paraphrase to check their understanding (90.9%).CONCLUSION: There were lapses in consent-taking procedure which were largely attributable to poor patient centeredness and respect for patients' autonomy among doctors, and the power gap between patients and doctors.Item Quality of informed consent obtained by doctors from patients undergoing surgical interventions in a tertiary care hospital in Sri Lanka(Sri Lanka Medical Association, 2018) Gunathunga, M.H.D.; Hansamali, M.M.P.; Hapuarachchi, H.S.M.; Herath, H.M.T.H.; Herath, H.M.C.J.; Chandratilake, M.N.INTRODUCTION AND OBJECTIVES: Respecting patient autonomy and obtaining consent for medico-surgical procedures are basic ethical principles. The objective of this study was to explore the perspective of doctors on lapses of taking consent observed in a surgical setting. METHODS: A qualitative. study using individual interviews was conducted with the participation of eight intern house officers working in surgical units of North-Colombo Teaching Hospital, Ragama. Their perspectives on previously observed lapses in consent-taking were explored. The audio-recorded interviews were thematically analyzed. ·RESULTS: Themes revealed the common lapses as: not explaining the risks and alternatives, checking understanding by paraphrasing, providing varying amounts of information to different patients, getting consent after admitting to the ward for surgery. Amount of information provided differed with perceived level of intellectual capacity of patients. Lack of knowledge on procedures was a challenge for junior doctors to provide information. Wards may not be the best place to provide information, but clinics, as patients have sufficient time to decide on the procedure before admitting. Lack of time and work overload were common barriers for all lapses identified. The basic information regarding risk, benefits alternatives and patient understanding was addressed not by a single doctor but by different doctors along the process. Doctors believed that some of these lapses were not expected by patients in the local context due to the culture and educational level. CONCLUSION: Although consent taking for surgery is adhered to as a practice, certain underlying principals maybe overlooked along the process due to limitations in resources and misperception of patients' expectations