Perceptions and practices regarding the process of obtaining informed consent from surgical patients at a tertiary care hospital

Patient knowledge of surgical informed consent and shared decision-making process among surgical patients in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Informed consent is one of the safeguarding of the patient in medical practice at different standards such as ethical, legal, and administrative purposes. Patient knowledge and perception of informed consent are one of the priority concerns in surgical procedures. Patient knowledge and perception towards informed consent increased patient satisfaction, feeling high power on their determination, and accountability for the management, and facilitated positive treatment outcomes. Despite this, in Ethiopia, there are small-scale primary studies with inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis study estimated the pooled prevalence of patient knowledge and perception of informed consent and its determinants in Ethiopia.

METHODS

We searched major databases such as PubMed, Hinary, MEDLINE, Cochrane Library, EMBASE, Scopus, African Journal Online (AJO), Semantic Scholar, Google Scholar, google, and reference lists. Besides this, University databases in the country were also searched from August 20, 2023, until September 30, 2023,. All published and unpublished studies that report the prevalence of patient knowledge and perception toward informed consent and its associated factors were included. All studies reported in English were included. Studies conducted between January 01, 2015 to September 30, 2023 were included. There are three outcome measurements pooled level of patient knowledge towards informed consent, pooled level of patient perception towards informed consent, and pooled effect that affects patient knowledge of informed consent. Three reviewers (MMM, NK, and YT) independently screened the articles that fulfilled the inclusion criteria to avoid the risk of bias. The studies' quality was appraised using a modified Newcastle-Ottawa Scale (NOS) version.

RESULTS

The pooled prevalence of appropriate patient knowledge and perception towards informed consent was 32% (95% CI: 21, 43) and 40% (95% CI: 16, 65) respectively. Having formal education 2.69 (95% CI: 1.18, 6.15) and having a history of signed informed consent before 3.65 (95% CI:1.02,13.11) had a statistically significant association with good patient knowledge towards informed consent.

CONCLUSION

The appropriate patient knowledge and perception of informed consent in Ethiopia is low. Formal education and history of signed informed consent were positive factors for appropriate patient knowledge of informed consent in Ethiopia. Physicians, policymakers, and health facility managers should focus on patients without prior experience with signed informed consent and not have formal education to improve patient knowledge towards informed consent. The protocol was registered at Prospero with number CRD42023445409 and is available from: https://www.crd.york.ac.uk/PROSPERO/#myprospero .

Operating Ethically: A Review of Surgical Ethics in Pakistan and Recommendations for the Way Forward

Medical ethics underpin the moral framework that delineates the professional relationship between physicians and their patients and thereby is an integral part of making patient-centric healthcare decisions. The concept of ethics is deeply embedded in the field of surgery as surgeons confront a myriad of dilemmas as a part of their routine, whether it be in a preoperative or postoperative environment. The current review aims to describe the state of surgical ethics in Pakistan, with the intent of encouraging dialogues about the ethical considerations relevant to the field surgery that will identify actionable areas for improvement. While most surgeons are aware of the traditional principles of ethics and their practice, their surgical and clinical decisions may fall short of these standards because of time constraints and prevailing cultural and religious beliefs and taboos. The rigorous application of ethical principles in areas of patient-related communication, such as consenting, trainee education, palliative and end-of-life care, and surgical innovation and research, will have significant implications for patients, surgeons, and society. Our review has identified the lack of formal bioethics education and insufficient oversight and ethical regulations to be at the core of inadequate ethical practices in Pakistan and has highlighted actionable areas to be addressed in the future.

Surgical Consent in the Pediatric Age Group: Parental Perceptions Toward Legal Aspects of Informed Consent

Background

The perceptions of parents/legal guardians may drive their decisions on providing informed consent for minors. Currently, no study from Saudi Arabia has assessed the perceptions of parents/legal guardians toward informed consent for pediatric surgical procedures.

Objective

To determine parents' perception and understanding of pediatric informed consent for surgeries from Saudi Arabia and determining their level of participation in the decision-making process of the treatment modality.

Methods

This observational cross-sectional study was conducted among parents from the Jazan region of Saudi Arabia with at least one child aged ≤ 12 years. Three aspects of surgical informed consent were evaluated: parents' awareness, attitude, and understanding of informed consent and its legal issues; the knowledge they sought during informed consent discussions; and parents' opinions about their respective roles in the decision-making process for the treatment.

Results

A total of 366 responses were included in this study. More than 95% of the participants agreed that informed consent was necessary; however, 94.7% felt that regardless of their beliefs, they had to sign the form. Surprisingly, the majority (61%) believed that any relative can sign the consent form on behalf of the parents/legal guardian. Most respondents believe that pre-operative procedures (80.8%), the cost (93.9%), and the reason for the procedure and its alternatives (87.2%) should be discussed when informed consent is being sought. About 76.5% of the participants wanted to know all the information regarding the procedure; of these, 48.3% responded that they would play a role in deciding the eventual treatment modality.

Conclusion

The findings of this study indicate the need to increase knowledge regarding surgical informed consent among parents in the Jazan region of Saudi Arabia.