Consent For Surgery Research Articles

Attitudes Towards Informed Consent: A Comparison Between Surgeons Working in Saudi Arabia and the United Kingdom

Changes in legal standing and new guidelines for consent have generated changes in medical culture that doctors must adhere to. This study aims to highlight the differences in the way the surgeons in the two cultures view the informed consent for surgery processes. The attitudes towards informed consent of a group of surgeons working in Saudi Arabia (KSA) were compared with those of a similar group working in the United Kingdom (UK), a country with a longer medical history and a more established medico-legal system. The study shows that KSA surgeons tend to view informed consent not only as an ethical and legal obligation but also as a benefit to patients. In addition, KSA surgeons are more likely to adopt a paternalistic attitude during informed consent. They believe that information about harmful risks may dissuade their patients from undergoing the operation and they admit that the amount of information they provide to their patients is significantly influenced by a number of patient and non-patient related factors. It is concluded that surgeons in KSA should be more aware of the informed consent guidelines and they should adhere to them. In addition, there is room for the introduction of formal training on informed consent in both countries and for making written information more widely available particularly in KSA.

What Information Should Surgeons Discuss With Patients During Informed Consent For Innovative Surgery?

What Information Should Surgeons Discuss With Patients During Informed Consent For Innovative Surgery?

Problems related to informed consent in surgery and recommendations

Problems related to informed consent in surgery and recommendations

The effect of a visual aid on the comprehension of cataract surgery in a rural, indigent South Indian population

To determine whether a visual aid improves the understanding and retention of information presented during informed consent for rural, indigent patients presenting for cataract surgery. This was a randomized, unmasked, interventional study. We recruited patients who presented to the Hande Surgical Hospital in Chennai, India, for cataract surgery. Patients were randomized into two groups: verbal consent alone (group A) and verbal consent plus a poster (group B). Both groups completed an 11-question true/false quiz immediately before and after informed consent and one day after surgery. A total of 60 patients were recruited for the study, with 30 randomly assigned to each group; 23 patients from group A and 17 from group B completed the study. Informed consent improved patient scores in both groups; however, group B had significantly higher mean scores on postoperative day 1 (7.4 vs 8.7, P = 0.005) and significantly greater improvement in mean scores from pre-informed consent to postoperative day 1 (1.3 vs 3.6, P = 0.002). Informed consent improves patient understanding of cataract surgery. Using a visual aid during informed consent for cataract surgery improves understanding and retention of information more than verbal consent alone in a rural South Indian population.

Informed Consent in Oral Surgery: The Value of Written Information

To evaluate the efficacy of the written explanation given to patients when obtaining informed consent for oral surgery, taking the surgical extraction of the impacted mandibular third molar as the clinical model for this study. This study included 87 patients requiring surgical extraction of an impacted lower third molar. Residents of the Oral Surgery Department explained verbally and in writing 7 possible complications that could arise as a result of the operation, after which informed consent was obtained from the patient. These complications were as follows: altered sensation of the homolateral lower lip and chin; altered sensation of the tongue; swelling; trismus; pain; allergies; and infection. The patients completed a Corah anxiety test on the same day, as well as a preoperative questionnaire about their level of understanding of the informed consent. Seven days after the operation, the patients returned to have their stitches removed and for a postoperative interview. A total of 87 patients participated in the study. Of these, 64% (n = 56) had understood the objective of the informed consent. All but 1 (1%) of the patients remembered having been informed of the possible risks before the operation. Changes in sensation of homolateral lower lip and chin (98%, n = 85) and of the tongue (86%, n = 75) were among the complications most recalled by the patients. Ninety-six percent of patients (n = 84) preferred to be informed preoperatively, and 71% (n = 61) described the signs and symptoms to be exactly as explained by the residents. Patients do not remember the majority of the information they receive before giving informed consent. Paresthesia of the lower lip and chin on the operated side and of the tongue are among the most recalled complications. This may be due to the seriousness of this complication, to the effect it can have on the patients' daily life, and to the possibility that it may be irreversible.

Clinical Issues—November 2010

This MonthResponsibility for obtaining the surgical informed consentKey words: surgical consent, consent for surgery, informed consent.Requirement for a history and physical examination before minor surgeryKey words: patient history, physical examination, H&P, minor surgical procedures.Marking instruments with color‐coded tapeKey words: instrument tape, color‐coded tape, sterilization.Wearing perfume in the perioperative settingKey words: perfume, fragrance‐free health care environments, sensory hyperreactivity.

Surgeons' opinions and practice of informed consent in Nigeria

BackgroundInformed consent is perhaps more relevant to surgical specialties than to other clinical disciplines. Fundamental to this concept is the provision of relevant information for the patient to make an...

Choroidal neovascularization in a young, healthy eye after LASIK

Background Choroidal neovascularization (CNV) is associated with age-related macular degeneration (AMD), degenerative myopia, angioid streaks, presumed ocular histoplasmosis syndrome, and numerous other ocular and systemic conditions. Idiopathic CNV is also a common form of the condition. However, CNV has rarely been noted after laser-assisted in situ keratomileusis (LASIK) and a cause-and-effect relationship has not been found. A case of CNV after uneventful LASIK is reported here, along with a literature review of previously reported cases and suggested pathophysiology. A link between LASIK and CNV is sought. Methods A case report of CNV in a young, healthy eye after uneventful LASIK is presented. Review of the pertinent literature reporting a relationship between LASIK and CNV was conducted through 2007, and few studies are reported after 2005. Conclusion To date, there is anecdotal evidence of CNV after LASIK. The incidence from prior reports ranges from 0.003% to 0.33%. However, a causal link cannot be disregarded and merits further study. Each patient undergoing LASIK warrants a thorough preoperative dilated fundus examination, including a thorough examination of the macula. This occurrence, albeit rare, should be considered for inclusion in the refractive surgery consent form.

Uninformed Consent for Children Undergoing Operations

Archives of Otolaryngology—Head & Neck Surgery Informed Consent in Pediatric Surgery: Do Parents Understand the Risks? Daniel P. Nadeau, MD; Jeremy N. Rich, MD; Scott E. Brietzke, MD, MPH Objective: To investigate parental understanding of the risks of pediatric ear, nose, and throat surgery after receiving counseling with and without the use of informational aids. Design: Prospective, randomized trial. Setting: Academic tertiary care center. Participants: Parents of children undergoing ear, nose, and throat surgery. Interventions: Parents were randomized to receive standard informed consent with or without detailed informational aids. Main Outcome Measures: Parents completed identical questionnaires testing their general procedure knowledge and their recall of 9 specific surgical risks both immediately after counseling and on the day of surgery. Results: Thirty-four parents enrolled in and completed the study (18 in the control group and 16 in the test group). The mean time from informed consent to surgery was 6.3 days (range, 1-22 days). Parents in the test group scored significantly higher on identifying the 9 risks on both the preoperative questionnaire (mean score, 6.00 vs 4.44;P = .007, 2-tailedttest) and the postoperative questionnaire (6.25 vs 4.17;P Conclusions: Parents of children undergoing ear, nose, and throat surgery recall far less than 100% of counseled risks. The use of detailed surgical risk counseling improves measured parental understanding of surgical risk. Parental educational level and maternal vs paternal parent may affect risk counseling recall.

A Premature Infant With Necrotizing Enterocolitis Whose Parents Are Jehovah's Witnesses

With this article, we introduce a new feature in Pediatrics called “Ethics Rounds.” The goal of this new feature is to present clinical cases that raise ethical issues. We present each case to pediatricians and bioethicists, who comment on the case on the basis of the information that they have at the time. We then give these same commentators the conclusion of the case and ask for further reflections. The case is printed in italic font, and comments are in normal, Roman font. To protect patient privacy, we change certain facts of each case. Thus, although the reports are based on real cases, the names, ages, location, and gender of the patient may be changed if they are not relevant to the central issues of the case. We invite readers to submit cases to the editor of Ethics Rounds: John Lantos, MD (jlantos@cmh.edu). Our first case involves an extremely premature infant who developed necrotizing enterocolitis (NEC). We presented the case, as it evolved, to 2 experienced pediatrician-bioethicists, Dr William Meadow and Dr Chris Feudtner. We then asked another pediatrician-bioethicist, Armand H. Matheny Antommaria, who has training in religious ethics to comment on the case and the discussion. Infant Smith was born at 25 weeks' gestation by emergency cesarean delivery after placental abruption. His birth weight was 475 g. He was stable for the first 4 days. A head ultrasound on day 2 showed a grade II intraventricular hemorrhage on the right. He had oxygen saturation levels of 94% on low ventilator settings. On day 5, Infant Smith experienced a decrease in oxygen saturation and abdominal distension. An abdominal radiograph showed free air in the abdomen. A surgical consult was obtained, and an exploratory laparotomy was scheduled. As part of the consent for surgery, the parents were asked to consent … Address correspondence to John Lantos, MD, Children's Mercy Bioethics Center, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: jlantos{at}cmh.edu

Informed Consent in Pediatric Surgery

To investigate parent understanding of the risks of pediatric ear, nose, and throat surgery after counseling with and without the use of informational aids. Prospective, randomized trial. Academic tertiary care center. Parents of children undergoing ear, nose, and throat surgery. Parents were randomized to receive standard informed consent with or without detailed informational aids. Parents completed identical questionnaires testing their general procedure knowledge and their recall of 9 specific surgical risks both immediately after counseling and on the day of surgery. Thirty-four parents enrolled in and completed the study (18 in the control group and 16 in the test group). The mean time from informed consent to surgery was 6.3 days (range, 1-22 days). Parents in the test group scored significantly higher on identifying the 9 risks on both the preoperative questionnaire (mean score, 6.00 vs 4.44; P = .007, 2-tailed t test) and the postoperative questionnaire (6.25 vs 4.17; P < .001). There was a negative correlation (inverse relationship) between parent education score and risk recall, with parents with lower education levels scoring higher on both the preoperative (Pearson r = -0.36; P = .04) and the postoperative (r = -0.35; P = .04) surveys. The maternal parent recalled risks significantly better than the paternal parent, with surgical risk recall scores of 5.46 out of 9 vs 3.67 out of 9 (P = .02, 2-tailed t test). Parents of children undergoing ear, nose, and throat surgery recall far less than 100% of counseled risks. The use of detailed surgical risk counseling improves measured parental understanding of surgical risk. Parental educational level and maternal vs paternal parent may affect risk counseling recall.

Changes in surgical consent practices for common otolaryngology procedures: impact of Modernising Medical Careers

To assess elective surgery consent practices amongst senior house officers from a selection of UK ENT departments, and to compare results with similar surveys in 2002 and 2005. A telephone survey of senior house officers in 40 UK ENT departments was conducted to assess departmental consent policies and knowledge of complications of common ENT operations. A total of 77.5 per cent of responding senior house officers were responsible for consenting, reduced from 92.5 per cent in 2002 (p = 0.06). There had been a significant improvement in the use of patient information sheets, from 25 per cent of departments in 2002 to 65 per cent in 2008 (p = 0.0002). There had been no improvement in training or in the use of standard National Health Service consent forms, and the senior house officers' knowledge of specific complications remained poor. Of the senior house officers surveyed, 37.5 per cent were foundation trainees. There has been some improvement in information delivery to patients during the consent process, in accordance with General Medical Council, Department of Health and Modernising Medical Careers guidelines. However, most senior house officers are still required to obtain patient consent without appropriate training.

The evolution of consent

The evolution of consent

Anaesthetists' and surgeons' attitudes towards informed consent in the UK: an observational study

BackgroundThe attitudes of patients' to consent have changed over the years, but there has been little systematic study of the attitudes of anaesthetists and surgeons in this process. We aimed to describe observations made on the attitudes of medical professionals working in the UK to issues surrounding informed consent.MethodA questionnaire made up of 35 statements addressing the process of consent for anaesthesia and surgery was distributed to randomly selected anaesthetists and surgeons in Queen's Medical Centre (Nottingham), Royal Sussex County Hospital (Brighton) and Eastbourne District General Hospital (Eastbourne) during 2007. Participants were asked to what extent they agreed with statements regarding consent.ResultsOf 234 questionnaires distributed, 63% were returned. Of the respondents 79% agreed that the main purpose of the consent process is to respect patient autonomy. While 55% of the examined cohort agreed that the consent process maybe inappropriate as patients do not usually remember all the information given to them. Furthermore, 84% of the participants agreed that what the procedure aims to achieve should be explained to the patient during the consent process. While of the participants, over 70% agreed that major risks of incidence greater than 1/100 should be disclosed to the patient as part of the consent process.ConclusionsThe majority of respondents appear to hold attitudes in standing with current guidelines on informed consent however there was still a significant minority who held more paternalistic views to the consent process bringing into question the need for further training in the area.

Surgical challenges in the treatment of advanced cases of ameloblastoma in the developing world: The authors’ experience

Total mandibulectomy was carried out in 32 patients with extensive oro-facial lesions histologically diagnosed as ameloblastoma in four specialist centres in south-eastern Nigeria from January 2001 to December 2006. All the patients presented at an advanced stage with the whole mandible affected so the treatment of choice was total mandibulectomy. The patients gave informed consent for surgery. The standard surgical procedure was the same in all cases and was performed by the same surgeons. Of the 32 mandibles removed, there were 13 male (41%) and 19 female (59%) patients, giving a male-to-female ratio of 1:1.6. Three (9%) patients died due to problems relating to anaesthesia while five (16%) had postsurgical-related psychosomatic problems. Generally, the postoperative recovery was characterized by reduction in the quality of life of these patients because immediate jaw reconstruction was not feasible. This article highlights the challenges in the surgical management of advanced cases of ameloblastoma in the developing world and proposes a middle ground for professional interactions and exchange programmes among oral and maxillofacial surgeons across the world to assist poorer countries in the management of these advanced cases of oro-facial tumours.

Are patients with fractured hips giving valid consent for surgery?

Introduction: Proximal femoral fractures (intracapsular and extracapsular) most commonly occur in the elderly due to falls, with a higher incidence in women. With the UK population ageing, the incidence of fracture neck of femurs (NOF) has been steadily increasing. In 2007 there were 70,000 NOF fractures treated in the NHS. This number is expected to rise to 91,500 per annum by 2015. The aim of this observational prospective study was to see whether consent comprehension was related to AMTS in an elderly patient with a proximal femoral fracture. Materials and methods: Sixty four patients with hip fractures were included in this study. The patient was consented and an abbreviated mental test score (AMTS) was recorded on admission. Preoperative comprehension was judged using a questionnaire. Univariable linear regression analysis was performed. Results: A significant correlation between the AMTS and consent comprehension scores was found r 2 = 0.680 (p < 0.0001). Conclusion: We showed a strong correlation between the AMTS and consent comprehension in this patient group. We concluded that due to variation in comprehension scores for a defined AMTS, we could not state above what AMTS a patient can be deemed to have significant comprehension of their consent. Consent training should me mandatory for surgical doctors and that it should not be a one off event, but instead a continuum of events.

Team Management of Voice Disorders in Singers

Team Management of Voice Disorders in Singers

Informed consent for surgery in Nigeria: Is the practice adequate?

To evaluate the adequacy of the use of informed consent in surgical practice from the patients’ perspective. The study was carried out in the department of Surgery, University of Calabar Teaching Hospital, Calabar, over a six-month period. A structured questionnaire was administered post operatively on patients, and parents/guardians of minors, who agreed to participate in the exercise. Data obtained included sociodemographic characteristics, description of surgery they had, whether surgical procedure was explained to them pre operatively or not, who gave the explanation, their level of understanding and their opinion on the process of obtaining the consent. Ninety one patients participated in the study. Male to female ratio was 3.8:1, with average age of 33.6 years (SD ± 13). Most of them (94.6%) had some level of formal education. Seventy nine patients (86.8%) knew the description of the surgical procedure. Pre operative explanation of the surgical procedure was given to 70.3% of the patients but 27.5% of these did not understand the explanation. A significant number of the patients (51.6%) were not satisfied with the explanation given. Even though all the patients had the consent form signed either by themselves or on their behalf by a close relative, 46.2% of them did not understand the content of the consent form and 67.1% did not understand the implication of what they had signed. The practice of informed consent for surgery is not adequate. Surgeons need to be further educated to improve their practice in this regard. The consent process needs to be simplified to enhance patients’ understanding and participation.

The provision of information for patients prior to cataract surgery

This clinical audit evaluates the provision of patient information. It also establishes patients' views on satisfaction regarding the information provided at nurse-led preoperative assessment prior to giving informed consent for cataract surgery. A quantitative descriptive audit was conducted using a questionnaire, by which the questions reflected the baseline standards. A convenience sample of 75 postcataract patients took part in this retrospective audit. All 75 patients stated that they were either 'very satisfied' or 'satisfied' with both the verbal explanation and written information received, and identified the preoperative assessment nurse as the main source of information.

Consent for surgery: will you be doing my operation, doctor?

Consent for surgery: will you be doing my operation, doctor?