factors influencing quality of informed consent among general surgical and gynacological patients at Muhimbili national hospital

Abstract

Objectives: A prospective study comprising interviews with patients and then completing standard questionnaires was conducted among surgical patients at Muhimbili National Hospital from April 2009 to January 2010. The aim of the study was to examine the factors influencing quality of informed consent at surgical and gynaecological unit of the largest teaching hospital. Methods: Two hundred and thirty two (107 men, 125 women) patients undergoing intrathoracic, intraperitoneal and intra pelvic procedures were involved. One patient died before the discharge day. Operation information cards were allocated to 116 patients and the other half of patients received only oral information. The patients were asked to recall information at various points before and after surgery; this score was compared by age, provision of written information and confidentiality status. Results: It was observed that the patients were best informed on the day of discharge (81.4%). Old age adversely affected recall of information at all assessment points. Operation information cards improved recall of information. Almost all patients let their relatives to know about their disease status.

Conclution: In conclusion it has identified that the process approach rather than single event approach with regard to procedures of gaining informed consent improves the rate of recall of information. The Junior Doctors are the most effective in imparting information relating to surgical treatment despite the fact that are not the ones carrying out the procedures. Elderly patients are likely to recall information relating to their surgery poorly. It also noted that written information is helpful. Out of culture medical confidentiality is not maintained in daily practice in this setting.

Recommendations: It was stated that the way forward is:

 Extra effort is needed to improve procedures of gaining informed consent from elderly patients which includes, asking patient to recall establishing understanding, adding additional stimuli which includes , providing written information and approach should be process approach rather than single event approach.  Written information should be given in addition to oral information to all patients.

 Study is needed to evaluate the position and quality of the relatives' opinion in the decision making by the patient during process of obtaining informed consent.