An audit of the level of knowledge and understanding of informed consent amongst consultant orthodontists in England, Wales and Northern Ireland

Abstract

To determine the level of knowledge and understanding of informed consent amongst consultant orthodontists. A questionnaire which covered a range of legal issues on informed consent as it pertains to clinical practice in three of the four nations of the United Kingdom. Hospital orthodontic departments in England, Wales, and Northern Ireland. A questionnaire was initially issued to 14 consultant orthodontists working in the East of England as a regional audit project on informed consent in 2005. After the completion of the audit in 2006, the pilot data were used to refine the questionnaire for wider circulation. The project was then submitted to the British Orthodontic Society (BOS) clinical effectiveness committee which subsequently gave its endorsement for national circulation. The questionnaire was then sent to 216 other consultants in June 2007, with two further postings to non-responders before the survey was closed four months later. The standard required for clinical practice to be lawful is that all of the questions should be answered correctly. Of the 233 consultant orthodontists who were invited to participate, 183 complied (78.5%) and 50 did not (21.5%). Of those who responded, 179 answered the questionnaire (76.8%) while four had either resigned or retired (1.7%). Out of the 21 answers to the 11 questions that were posed, the mean, median and mode correct response rates were 12 (57%), 11 (52%), and 10 (48%) respectively. The areas which were found to have the poorest level of understanding included what explanations patients need from clinicians in order for them to give consent, how to fully judge if a patient is capable of giving consent, how to manage a patient deemed incapable of giving consent, the legal status of fathers consenting on behalf of their children, whether consent forms have to be re-signed if the start of treatment is delayed by six months or more, and that dentists referring a patient for treatment requiring a general anaesthetic have the same duty to receive consent for the anaesthesia as do the clinicians who will be performing the surgical procedure. The results of this audit indicate certain key areas of deficiency in the knowledge and understanding of informed consent amongst consultant orthodontists. The findings provide an opportunity for all clinicians to improve their education and therefore their potential to comply with both the ethical obligation and the legal requirement of gaining valid consent before the start of any treatment.