Patients' and Healthcare Professionals' Perspectives on Preoperative Informed Consent Procedure Obstacles and Potential Solutions, 2021: A Qualitative Study

Background

Informed consent discussions are individualized not only with regard to the patients' surgical condition and goals but also with their varying information needs, health literacy, and anxiety. Information is lacking regarding the views of patients and concerned healthcare professionals on the informed consent process.

Objective

This study is aimed to explore patients' and healthcare professionals' perceived barriers during informed consent process and identify suggested solutions for improvement.

Methods

Patients who underwent elective surgery, anesthetists, and surgeons were the subjects of a qualitative study employing focused group discussions and in-depth interviews. The study participants were chosen through the use of purposeful sampling.

Results

The main barriers identified by the patients include: inadequate explanation about the intended procedure, family's influence in the decision-making, fear of surgery, fear of light/power interruption, inadequate time for discussion, and not letting the family members attend the discussion. On the other hand, healthcare professionals also identified various barriers, which includes: inability of patients to understand the information, limited time to discuss with patients in detail, poorly designed informed consent form, poor awareness of patients, fear of patient refusal for surgery if the risks and associated health problems are explained, lack of adequate investigation to confidently explain about the disease condition, use of medical jargons, poor documentation habit of professionals and lack of legal system regarding ethical dilemmas.

Conclusions and Recommendation

Patients and healthcare professionals have identified avoidable barriers that need the attention of concerned health professionals, educators, and the healthcare delivery system.

Patients' satisfaction and associated factors towards preoperative informed consent process: A cross-sectional study

Background

Informed consent is a process that needs time and effort to satisfy patients' desires. Patient dissatisfaction on preoperative informed consent process may be caused by multiple factors of clinical practice. This study aimed to assess patients' satisfaction and associated factors of informed consent process among elective surgical patients.

Methods

A cross-sectional study was conducted on 404 postoperative patients who signed the informed consent for elective surgery. A systematic sampling technique was applied to select the study participants. Modified Leiden perioperative patient satisfaction tool was adapted to assess patients' satisfaction with preoperative informed consent process. Data were entered in to Epi-data version 4.20 and exported to SPSS version 20 for analysis. Bivariate and multivariable logistic regression was computed to identify independent variables associated with patient satisfaction towards preoperative informed consent process. A p-value of less than 0.05 was used to declare the statistical significance.

Results

The overall satisfaction of patients with preoperative informed consent process was 70.3%. Multivariable logistic regression analysis revealed that, being male (AOR: 4.75, 95% CI: 2.47-9.16), primary school (AOR: 8.42, 95% CI: 4.74-7.55), secondary school (AOR: 2.17, 95% CI: 5.74-8.62), rural residence (AOR: 1.8, 95% CI: 2.1-3.9) and received general anesthesia (AOR: 2.92, 95% CI: 1.62-5.26) were significantly associated with patients' satisfaction with the informed consent process.

Conclusion

The overall patients' satisfaction on preoperative informed consent process was relatively low. Being male, low level of education, living in rural area, and receiving general anesthesia were significantly associated with patients' satisfaction on informed consent process. Surgeons and anesthesia professionals need to work more to improving the satisfaction of patients with preoperative informed consent process. Researchers are expected to do periodic assessment of patients' level of satisfaction and factors affecting satisfaction.

Knowledge, attitudes and practices of health professionals towards postoperative pain management at a referral hospital in Ethiopia

BACKGROUND

Postoperative pain (POP) is a form of acute pain following surgery. It results from tissue injury during surgical procedure like skin incision, tissue dissection, manipulation and traction. It is one of the immediate postoperative complications. Despite new standards, guidelines and different strategies the practice of postoperative pain management is found to be inadequate. We aimed to assess knowledge, attitude and practice on postoperative pain management practice among Health professionals working at XX Referral Hospital.

METHOD

Institution based cross-sectional study was conducted to assess Knowledge, Attitudes and Practices of Health professionals regarding to Post-operative pain management at XX Referral Hospital 2020 from 118 health professionals. Data was collected using structured self-administered questionnaire and was verified, coded and entered to Epi Info Software version 3.5.4 and then it was exported and analyzed by SPSS version 20 Software. After analysis frequency and percentages was used to summarize the finding.

RESULT

The overall finding of the study revealed that health professionals had good knowledge (58.4%), unfavorable attitude (44.9%), and poor practice (24.58%) towards post-operative pain management.

CONCLUSION

Non physician anesthetists have good knowledge, attitude and practice towards post-operative pain management. But the overall attitude and practice of health professionals' towards post-operative pain management is poor.

Lived Experience of Women Who Underwent Early Removal of Long-Acting Family Planning Methods in Bedesa Town, Wolaita Zone, Southern Ethiopia: A Phenomenological Study

Background

Long-acting family planning method (LAFP) is a low-cost yet effective method of reducing maternal mortality, limiting and spacing childbirth. In Ethiopia, the family planning prevalence rate rises from 15% in 2005 to 36% in 2016. However, the discontinuation rate of LAFP is still high in the region. Therefore, the aim of this study was to explore the lived experiences of women who underwent early removal of long-acting family planning methods in Bedesa town, Southern Ethiopia.

Methods

An interpretative phenomenological study design was employed. Women aged 15–49 years who removed LAFP therapy in the past 12 months were our sampled population. Data were collected through in-depth interviews (IDIs) by using open-ended structured interview guide. Purposive sampling technique was used to select 10 participants from the family planning logbook registration of Bedesa health center. The interview continued until information saturation was reached. Open code version 4.03 was used to code and facilitate analysis. Transcripts were read and re-read separately to identify emerging themes. A thematic analysis technique was used.

Results

This study revealed that the side effects, seeking more children and the husband’s opposition were the main reason for early removal of LAFP. Amongst side effects, heavy and irregular menses were occurred most frequently. Besides, there were various myths and misconceptions about family planning methods. It also noted that the counseling services provided by health professionals were not adequate.

Conclusion

Side effects, desired to have more children, and the husband’s opposition are the most important reason of early removal of LAFP methods. Furthermore, there were misunderstanding, fear and rumors raised by women about each method. Hence, greater public awareness on family planning should be delivered to change community perception on LAFP methods.