Quality of informed consent as experienced by patients awaiting surgical intervention in a tertiay care setting in Sri Lanka

Abstract

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.