Quality of informed consent obtained by doctors from patients undergoing surgical interventions in a tertiary care hospital in Sri Lanka

Abstract

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