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Mogili AR, Mukisa D, Campbell P, Giibwa A, Binoga M, Emoru A, Kalumuna AT, Damoi JO, Melendez C, Waye J, Marin ML, Zhang LP. Do patients actually understand? An evaluation of the informed consent process for endoscopic procedures in rural Uganda. Surg Endosc 2024:10.1007/s00464-024-10971-z. [PMID: 38877318 DOI: 10.1007/s00464-024-10971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Improving surgical access in low- and middle-income countries is vital for the 5 billion people who lack safe surgical care. Tailoring a culturally sensitive approach to consent is essential for patient comprehension and comfort, thereby alleviating the effects of resource constraints and advancing equitable care. This study examines the consenting process for endoscopy at Kyabirwa Surgical Center in Kyabirwa, Jinja, Uganda, to assess patients' knowledge and attitudes as a potential barrier to participating in endoscopic procedures. METHODS All adult upper endoscopy (EGD) and colonoscopy patients were recruited to participate in a survey of their demographics, knowledge, and attitudes toward their procedure. All patients received a standard consultation explaining the procedure and its risks and benefits. RESULTS 75 patients were included; median age was 54 years and 56% (n = 42) were women. 92% (n = 69) of patients had never had an endoscopy before and 73% (n = 55) of patients were scheduled for an EGD while the remaining 27% (n = 20) were scheduled for a colonoscopy. Most patients 80% (n = 60) had a basic understanding of what an endoscopy is and 87% (n = 65) its diagnostic purpose. Few patients 15% (n = 11) knew of the most common side effects or if they would have a surgical scar 27% (n = 20). Overall, 46.7% (n = 35) of patients were moderately or severely fearful of getting an endoscopy. Additionally, 45.3% (n = 34) of patients were moderately or severely fearful of receiving anesthesia during their endoscopic procedure. Despite this fear, most patients 85.3% (n = 64) stated that they understood the benefits of the procedure either very well or extremely well. CONCLUSIONS Most patients understood the role that an endoscopic procedure plays in their care and its potential benefits. Despite this, many patients continued to have high levels of fear associated with both the endoscopic procedure and with receiving anesthesia during their procedure. Future patient education should focus on addressing patients' fears and the risks of undergoing an endoscopy, which may improve the utilization of surgical services.
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Affiliation(s)
- Abhishek R Mogili
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Daniel Mukisa
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Peter Campbell
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Angellica Giibwa
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Moses Binoga
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Arthur Emoru
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Anna T Kalumuna
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Joseph O Damoi
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Chelsia Melendez
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Jerome Waye
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Michael L Marin
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Linda P Zhang
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA.
- Department of Surgery, Mount Sinai Hospital, 1468 Madison Ave, New York, NY, 10029, USA.
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Dickerson JC, Ibeka P, Inoyo I, Oke OO, Adewuyi SA, Barry D, Bello A, Fasawe O, Garrity P, Habeebu M, Huang FW, Mulema V, Nwankwo KC, Remen D, Wiwa O, Bhatt AS, Roy M. Implementing Patient-Directed Cancer Education Materials Across Nigeria. JCO Glob Oncol 2021; 7:1610-1619. [PMID: 34860566 PMCID: PMC8654433 DOI: 10.1200/go.21.00233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
As access to cancer care expands in low-income countries, developing tools to educate patients is paramount. We took a picture booklet, which was initially developed by the nonprofit Global Oncology for Malawi and Rwanda, and adapted it for use in Nigeria. The primary goal was to assess acceptability and provide education. The secondary goals were (1) to describe the collaboration, (2) to assess knowledge gained from the intervention, (3) to assess patient understanding of their therapy intent, and (4) to explore patient's experiences via qualitative analysis. In this cross-continent collaboration supported by @StanfordCIGH, low literacy-friendly cancer education booklets developed by @GlobalOnc increased awareness and knowledge about cancer treatment in 4 diverse sites in Nigeria.![]()
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Affiliation(s)
- James C Dickerson
- Department of Medicine (Hematology and Oncology), Stanford University, Stanford, CA
| | - Paulette Ibeka
- Clinton Health Access Initiative, Inc, Abuja, Federal Capital Territory, Nigeria
| | - Itoro Inoyo
- Clinton Health Access Initiative, Inc, Abuja, Federal Capital Territory, Nigeria
| | | | - Sunday A Adewuyi
- Oncology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
| | | | - Abubakar Bello
- Radiotherapy, Lagos University Teaching Hospital, Idi Araba Lagos, Nigeria
| | - Olufunke Fasawe
- Clinton Health Access Initiative, Inc, Abuja, Federal Capital Territory, Nigeria
| | | | | | | | - Vivienne Mulema
- Clinton Health Access Initiative, Inc, Abuja, Federal Capital Territory, Nigeria
| | | | | | - Owens Wiwa
- Clinton Health Access Initiative, Inc, Abuja, Federal Capital Territory, Nigeria
| | - Ami S Bhatt
- Global Oncology Inc, Oakland, CA.,Department of Medicine (Hematology, Blood and Marrow Transplantation) and of Genetics, Stanford Center for Innovation in Global Health, Stanford University, Stanford, CA.,Global Oncology, Oakland, CA
| | - Mohana Roy
- Department of Medicine, Oncology, Stanford University, Stanford, CA
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Wu CA, Dutta R, Virk S, Roy N, Ranganathan K. The need for craniofacial trauma and oncologic reconstruction in global surgery. J Oral Biol Craniofac Res 2021; 11:563-567. [PMID: 34430193 DOI: 10.1016/j.jobcr.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022] Open
Abstract
The global burden of surgical disease is concentrated in low- and middle-income countries and primarily consists of injuries and malignancies. While global reconstructive surgery has a long and well-established history, efforts thus far have been focused on addressing congenital anomalies. Craniofacial trauma and oncologic reconstruction are comparatively neglected despite their higher prevalence. This review explores the burden, management, and treatment gaps of craniofacial trauma and head and neck cancer reconstruction in low-resource settings. We also highlight successful alternative treatments used in low-resource settings and pearls that can be learned from these areas.
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Affiliation(s)
| | - Rohini Dutta
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, BARC Hospital (Government of India), Mumbai, India.,Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Sargun Virk
- Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, BARC Hospital (Government of India), Mumbai, India
| | - Kavitha Ranganathan
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
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