Informed Consent Practices in Anesthesiology: A National Survey of Informed Consent Preferences and Perceptions Among Practicing Anesthesiologists.

While there have been several studies examining the understanding and quality of informed consent in clinical trials of cancer therapies, there is limited empirical research on health practitioners' experiences on the informed consent process in cancer care, especially from low resource settings. This study explored health professionals' perspectives on information disclosure during the consenting process in cancer care. A qualitative descriptive approach was used to collect data. Face to face interviews were conducted with 10 purposively selected healthcare professionals who were actively involved in soliciting informed consent at a cancer treatment centre in Uganda. A thematic approach was used to interpret the results. There were five key themes, and these included information disclosure to patients; assessment of patients' cancer awareness, treatment preferences and expectations; informed consent practices; barriers to optimal informed consent and information disclosure; and recommendations for improving the consenting process. All respondents appreciated the value of disclosing accurate information to patients to facilitate informed decision making. However, the informed consent process was deemed sub-optimal. Respondents asserted that patients should be the psychological wellbeing of patients should be protected by mentally preparing them before disclosing potentially distressing information. All healthcare professionals were appreciative of the central role the family plays in the consenting process. Overall, informed consent practices were not ideal because of the several challenges. Inadequate time is devoted to information disclosure and patient education; there is lack of privacy; and informed consent documentation is poor. There is a need for significant improvement in informed consent practices and healthcare professional-patient communication.

Background: Informed consent practices in dermatology are unknown. Objective: Assess informed consent practices and opinions regarding minimum standards of care for dermatologic procedures. Methods/materials: 500 randomly-selected, American dermatologists received mailed surveys, listing 19 dermatologic procedures. For each procedure, responders selected the informed consent method-none, verbal only, written only, or written and verbal representing their usual practice and opinion regarding minimum standard of care. Procedures were grouped into: Destruction of non-malignant lesions, biopsy, electrodessication and curettage (ED&C), cosmetic, and excision (including Mohs surgery). Results: Among 97 responders, mean age (SD) was 50 years (10.7). The most common informed consent practice (*) and opinion regarding standard of care (+) was verbal only for destructive procedures (66.5%*, 67.8%+), biopsy(46%*, 55.7%+), and ED&C (49.6%*, 53.9%+). Written and verbal informed consent was most common for excision (62.1%*, 41.1%+) and cosmetics (70.7%*, 51.6%+). No consent was in frequent (6.2% of responses), more common for destruction (11.9%) than biopsy (5.8%), ED&C (6.6%), cosmetic (3.3%) or excision (2.9%) (p=0.0002). Multivariate regression analysis revealed factors predicting no consent (odds ratio>5, 95% confidence interval) including practice 25years (0.16, 0.018), and history of malpractice litigation (-0.13, 0.008). Conclusion: Numerous factors influence informed consent practices and opinions, including procedure type.

IntroductionWhile there have been several studies examining the understanding and quality of informed consent in clinical trials of cancer therapies, there is limited empirical research on health practitioners’ experiences on the informed consent process in cancer care, especially from low resource settings. This study explored health professionals’ perspectives on information disclosure during the consenting process in cancer care.MethodsA qualitative descriptive approach was used to collect data. Face to face interviews were conducted with 10 purposively selected healthcare professionals who were actively involved in soliciting informed consent at a cancer treatment centre in Uganda. A thematic approach was used to interpret the results.ResultsThere were five key themes, and these included information disclosure to patients; assessment of patients’ cancer awareness, treatment preferences and expectations; informed consent practices; barriers to optimal informed consent and information disclosure; and recommendations for improving the consenting process. All respondents appreciated the value of disclosing accurate information to patients to facilitate informed decision making. However, the informed consent process was deemed sub-optimal. Respondents asserted that patients should be the psychological wellbeing of patients should be protected by mentally preparing them before disclosing potentially distressing information. All healthcare professionals were appreciative of the central role the family plays in the consenting process.ConclusionOverall, informed consent practices were not ideal because of the several challenges. Inadequate time is devoted to information disclosure and patient education; there is lack of privacy; and informed consent documentation is poor. There is a need for significant improvement in informed consent practices and healthcare professional-patient communication.

INTRODUCTIONThis study was conducted to assess the informed consent practices during normal vaginal delivery (NVD) process and immediate postpartum care in the tertiary-level hospitals of Bangladesh.METHODSA cross-sectional study was conducted at Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in November 2015. The study population and respondents were mothers who gave normal vaginal childbirth within the past 24 hours and received postpartum care in the study sites (N=190). The interview of every alternate mother from the patient register was conducted by researchers using a structured questionnaire. Descriptive analysis of findings was carried out using MS Excel 2013.RESULTSThe study findings revealed the complete absence of informed consent practices during NVD and postpartum care in the tertiary-level hospitals in Bangladesh. Consent (not informed consent) was taken from 95% of the mothers before proceeding with the NVD process, 50–72% of examinations (except breast examination, 0%) and 8–72% of procedures during postpartum care. Choice and preferences of mothers for taking an alternative process/examination/procedure were absent in all cases.CONCLUSIONSThe Respectful Maternity Care (RMC) Charter endorsed informed consent as one of the basic rights of child-bearing women. Absence of informed consent practices in the study sites indicates disrespect to maternity care and violation of this right. The Standard Clinical Management Protocols of Bangladesh also lacks clarification of this right. Improvement of the existing protocol, increased awareness and practices are essential to address protection of this right.

Informed consent practices of physiotherapists in the treatment of low back pain

This study examined 115 master's‐level counseling students' preferences for content, timing, and method of programmatic informed consent. Students rated the majority of items as moderately or extremely important to receive, and they indicated a desire for the informed consent to be facilitated through a combination of both oral and written methods throughout their programs of study. Results reinforce and go beyond the Council for Accreditation of Counseling and Related Educational Programs (2009) and American Counseling Association (2005) expectations for informed consent. Implications for counselor education are discussed.

A survey was used to investigate whether psychiatry residents obtained informed consent for treatment from 3 hypothetical patients. Clinical vignettes describing 3 patients with (1) major depressive disorder being prescribed medication, (2) borderline personality disorder starting psychotherapy, and (3) neurotic character traits starting psychotherapy were distributed to psychiatry residents at 7 New York City-area training programs. Necessary components of an informed consent discussion were defined a priori by means of a literature review and consultation with experts in informed consent. Residents' responses to questions about the vignettes were then examined to determine whether the residents would engage in an informed consent discussion with the hypothetical patients. The study was conducted from January to March 2005. 108 (49%) of 220 subjects reporting on a total of 324 vignettes returned the questionnaire. Responses to 8/324 vignettes met the minimal criteria established for an informed consent discussion. More residents reported they would initiate discussions with the depressed patient compared to the borderline and neurotic patients about diagnosis and prognosis, information about the recommended treatment, and side effects. A measure of what residents revealed about themselves to patients was also greater for the depressed patient compared to the borderline and neurotic patients. When the informed consent criteria were made less restrictive (requiring only that residents provide information in response to patients' questions rather than initiate the discussion), 173/324 vignette responses met the criteria. Psychiatry residents did not initiate informed consent discussions with the hypothetical patients in this study, but they reported that they would provide appropriate information when asked by the patients. These results suggest that changing residents' passive approach to informed consent discussions might have a large impact.

Informed consent is a fundamental pillar of patient rights and is an essential part of good clinical practice. In 2019, the International Confederation of Plastic Surgery Societies launched a survey to collect feedback on informed consent practices, with an aim to develop an international guideline for cosmetic surgery. A 15-question survey was sent to delegates of the International Confederation of Plastic Surgery Societies for dissemination to their national society members. The survey comprised a range of quantitative and qualitative questions. Descriptive and thematic analysis was performed. There were 364 respondents. Over half of the respondents reported no local informed consent policy, whereas others noted national society, specialist college, or government policies. The majority of respondents believed that the performing surgeon should be responsible for obtaining informed consent with at least two face-to-face consultations. Most respondents agreed with a cooling-off period (duration based on procedure type and use of high-risk devices). Regarding cosmetic breast augmentation, the majority of respondents felt that the performing surgeon should be responsible for postoperative management, including cases that occur as part of surgical tourism. Some respondents incorporate financial consent as part of their informed consent practice. Most supported the development of an international informed consent guideline. Informed consent should result from face-to-face consultations with the performing surgeon. There should be a minimum cooling-off period. Postoperative surveillance should be available in all settings. The findings of this survey will help inform an international standardized informed consent guideline for cosmetic surgery.

BackgroundIt has been reported by some studies that the desire to be involved in decisions concerning one’s healthcare especially with regard to obtaining informed consent is related to educational status. The purpose of this study, therefore, is to assess the influence of educational status on attitude towards informed consent practice in three south-eastern Nigerian communities.MethodsResponses from consenting adult participants from three randomly selected communities in Enugu State, southeast Nigeria were obtained using self-/interviewer-administered questionnaire.ResultsThere were 2545 respondents (1508 males and 1037 females) with an age range of 18 to 65 years. More than 70% were aged 40 years and below and 28.4% were married. More than 70% of the respondents irrespective of educational status will not leave all decisions about their healthcare to the doctor. A lower proportion of those with no formal education (18.5%) will leave this entire decision-making process in the hands of the doctor compared to those with tertiary education (21.9%). On being informed of all that could go wrong with a procedure, 61.5% of those with no formal education would consider the doctor unsafe and incompetent while 64.2% of those with tertiary education would feel confident about the doctor. More than 85% of those with tertiary education would prefer consent to be obtained by the doctor who will carry out the procedure as against 33.8% of those with no formal education. Approximately 70% of those who had tertiary education indicated that informed consent was necessary for procedures on children, while the greater number of those with primary (64.4%) and no formal education (76.4%) indicated that informed consent was not necessary for procedures on children. Inability to understand the information was the most frequent specific response among those without formal education on why they would leave all the decisions to the doctor.ConclusionThe study showed that knowledge of the informed consent practice increased with level of educational attainment but most of the participants irrespective of educational status would want to be involved in decisions about their healthcare. This knowledge will be helpful to healthcare providers in obtaining informed consent.

African American Living Donors’ Attitudes About APOL1 Genetic Testing: A Mixed Methods Study

Background: The informed consent is an important patient's right, has to be considered by physicians. The concept of consent arises from the ethical principle of patient autonomy and basic human rights. Objectives: To assess the informed consent practice for elective surgeries then design a training program to improve the practice and assess the effectiveness of the program. Methods: A randomized controlled trial was conducted by102 medical staffs that were responsible for informed consent practice, in ophthalmic department where cataract surgery is provided, in general surgery department, and in obstetric department where elective cesarean section is provided divided into two groups experimental and control groups in three stages, pre and post intervention over a period of 14 months from January 2015 to February 2016 by using a structured observation checklist. Results: Chi-square analysis to the following variables gender, job title, experience, timing of informed consent did not show significant relationship between the experimental and control groups. However, by comparing them in the dimensions of the informed consent practice there were statistically significant in test group after intervention (p < 0.0001). And also the percentage of those with s practical and legal problems decreased in test group in comparison to control group after intervention. Conclusions: Interventional program for health care providers has been improved the practice of informed consent.

Although consent has long been accepted as necessary in maternity care, the concept of informed consent for planned vaginal birth has polarised maternity politics. The publication of the NSW Consent Manual outlines new standards of informed consent, signalling the need for examination of current maternity consent practices. To examine informed consent and disclosure of material risks in birth in a prospective qualitative study of midwives and obstetricians. Qualitative study using semi-structured interviews to examine practices and perspectives of obstetricians and midwives. Twenty-two telephone interviews were concluded. Five sub-themes were identified: (1) non-compliance with the NSW Consent Manual, (2) risk communication/informed consent in maternity care, (3) consent practices in instrumental birth, (4) who should deliver risk information and when (5) barriers to change in consent practice (obstetricians only). One hundred per cent of participants (18 obstetricians, 4 midwives) described risk communication/informed consent practices that were non-complaint with the standards set out in the 2020 NSW Consent Manual. Eighty-three per cent (15/18) of obstetricians reported that current hospital-wide maternity care practices in risk communication/informed consent are inadequate. Sixty-one per cent (11/18) of obstetricians specifically singled out informed consent practices regarding instrumental birth to be inadequate. Ninety-four per cent (17/18) of obstetricians believe that maternity care consent practices need to be improved. The results of this study indicate that material risks of vaginal birth, caesarean section and instrumental birth, are not routinely disclosed during antenatal courses. Urgent resources and structural change are required to uphold women's legal right to bodily autonomy.

Informed consent has been the central model for ethical decision making in clinical care and research. The goal of informed consent is to protect the right of a competent person to make his or her own health care decisions based on personal values and goals. But changes in health care practices, systems, and research have challenged this well-established goal. This paper examines these changes to show that decisions about care and research directed to individual patients rely more and more upon a population perspective. As a result, efforts to promote patient choice should attend to the ethical decision-making processes of institutions that create and sustain this perspective.

Functional endoscopic sinus surgery (FESS) is one of the more common procedures performed by otolaryngologists. Before performing FESS, surgeons are obligated to discuss the procedure and its risks through the process of informed patient consent. The study identifies current practices in informed consent for FESS and formulates guidelines for informed consent for FESS. Survey. Surveys were sent to 1000 American Academy of Otolaryngology-Head and Neck Surgery members in the United States. Surveys inquired about current informed consent practices related to FESS. Three hundred forty-six surveys were returned. Nearly 60% of respondents thought that 1% incidence of a complication warrants a discussion with patients. The percentage of respondents who discuss specific risks were as follows: bleeding, 96.7%; infection, 84.8%; cerebrospinal fluid leak, 99.1%; orbital injury, 96.7%; smell changes, 40.2%; cerebrovascular accident, 17.9%; myocardial infarction, 81%; and death, 28.0%. The study suggests that there is variability in specific informed consent practices for FESS among otolaryngologists. It also suggests that the incidence or severity of a complication does not necessarily correlate with whether or not it is mentioned during the informed consent process. The authors think that practicing otolaryngologists may be able to use this information to improve their consent practices.

The purpose of this article is to characterize current informed consent practices for diagnostic CT scans at U.S. academic medical centers. We surveyed 113 radiology chairpersons associated with U.S. academic medical centers using a survey approved by our institutional review board. The need for informed consent for this study was waived. Chairpersons were asked if their institutions have guidelines for nonemergent CT scans (by whom; oral and/or written), if patients are informed of the purpose of their scans (by whom), what specific risks are outlined (allergic reaction, radiation risk and dose, others; by whom), and if patients are informed of alternatives to CT. The study response rate was 81% (91/113). Of the respondents, two thirds (60/90) currently have guidelines for informed consent regarding CT scans. Radiology technologists were most likely to inform patients about CT (38/60, 63%) and possible risks (52/91, 57%), whereas ordering physicians were most likely to inform patients about CT's purpose (37/66, 56%). Fifty-two percent (30/58) of sites provided verbal information and 5% (3/58) provided information in written form. Possible allergic reaction to dye was explained at 84% (76/91) of sites, and possible radiation risk was explained at 15% (14/91) of sites. Nine percent (8/88) of sites informed patients of alternatives to CT. Radiology technologists are more likely to inform patients about CT and associated risks than their physician counterparts. Although most academic medical centers currently have guidelines for informed consent regarding CT, only a minority of institutions inform patients about possible radiation risks and alternatives to CT.