The informed consent status for surgery patients in eastern Turkey: a cross-sectional study
Department of public health, School of Medicine, Gazi Osman Pasa University,Tokat, Turkey. Indian Journal of Medical Ethics
(Impact Factor: 1.07).
This study assesses the quality of the informed consent process and satisfaction with the informed consent process, for surgery patients in Turkey. Four hundred and eighty three patients were interviewed after their surgeries. More than half of the patients were satisfied with the information on eight issues that pertained to the informed consent process. A majority of patients (91 per cent) were satisfied with the information regarding why an operation necessary. However, only 205 of 483 patients(42 per cent) indicated that they had received sufficient information on the potential side effects and complications of surgery. Patients' educational level and the type of surgery--urgent or elective--were associated with the satisfaction status.
Available from: Rahime Aydin Er
- "In Turkey there are some deficiencies in informing not only patients with psychiatric disorders but also other patients about their diseases and possible therapies (Turla et al., 2005; Egri et al., 2008; Er et al., 2011). "
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ABSTRACT: Competence is a prerequisite for informed consent. Patients who are found to be competent are entitled to accept or refuse the proposed treatment. In recent years, there has been an increased interest in studies examining competence for treatment in psychiatric patients. In this study, we aimed to investigate the decision-making competencies of inpatients with a range of psychiatric diseases.
This study was carried out at the psychiatry clinic of Kocaeli University Hospital in Turkey from June 2007 to February 2008. Decision-making competence was assessed in 83 patients using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T).
The study groups consisted of patients with mood (39.8%), psychotic (27.7%) and anxiety disorders (18.1%), and alcohol/substance addiction (14.5%). There was a significant relation between decision-making competence and demographic and clinical characteristics. Appreciation of the given information was more impaired in psychotic disorder patients than in other patients, but understanding and reasoning of the given information was similar in all groups.
These results reveal the importance of evaluating decision-making competencies of psychiatric patients before any treatment or intervention is carried out to ascertain their ability to give informed consent to treatment. Institutional and national policies need to be determined and put into practice relating to the assessment and management of competence in patients with psychiatric disorders.
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ABSTRACT: Obtaining informed consent before performing invasive procedures and operations has become a standard practice at all medical institutions in the United States. All agree that patients should be both conscious of and in agreement with their medical care. Though patients routinely sign consent forms with numerous risks and complications detailed, there are only a limited amount of reports that study if these patients have a thorough understanding of those risks and complications. Confounding the issue of the efficacy of informed consents is the growing population of patients who do not speak English. To obtain objective data on the efficacy of informed consents and the role of language barriers we looked at how well patients who consented to have a laparoscopic cholecystectomy understood the complications associated with this procedure.
We conducted a randomized prospective study of all patients seen in the General Surgery Resident Outpatient Clinic who presented for an elective cholecystectomy. Fifty patients agreed to participate in our study. Participants were split into two groups. In the first group (the control group) surgical benefits, risks and complications were explained in the usual fashion. In the second group, after hearing the standard explanation of surgical risks, complications and benefits, patients watched a PowerPoint presentation with illustrations on laparoscopic cholecystectomy. Patients from both groups then took a ten question assessment based on the presentations that they encountered. Spanish speaking patients were addressed with an interpreter and given a Spanish PowerPoint presentation with a Spanish assessment. The patients' age, education level, income, and birth country were also studied.
Fifty-two percent of the patients in the study were born outside of the United States. All of the non-US born patients were Hispanic and their primary language was Spanish. The average age of the studied patients was 38. Sixty-eight percent of the patients reported an education level no higher than high school. The majority of the studied patients noted an income of less than $40,000. Differences were seen between patient native to the US and those born outside the United States. US born patients had an 80% correct response rate versus non-US born patients who had only a 63% correct response. Differences were seen between US born patient and non-US born patients concerning the topics of the severity of a common bile duct injury, gastrointestinal changes after cholecystectomy and the safety concerning conversion from laparoscopic to open cholecystectomy. No difference was appreciated in the PowerPoint group versus the non-PowerPoint group.
The addition of a PowerPoint presentation did not increase understanding of the risks and benefits associated with a laparoscopic cholecystectomy. This study did however highlight the problem of obtaining consent from foreign born patients. Patients who were not US natives showed a decreased understanding of the surgical procedure and the severity of the complications in both the control group and the PowerPoint group. Better methods of educating foreign patients should be investigated to truly obtain informed consents from this patient population.
Available from: Aslihan Akpinar
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ABSTRACT: Objective: We aimed both to identify the probable ethical problems related to informed consent in orthopedics clinics and to gather information about the procedures during the acquision of informed consent and clarity of surgical consent forms. Material and Methods: Current study was performed between February 2006 and February 2007 at the Orthopedic clinic at the Kocaeli University Hospital. The study form was prepared by researchers and it was filled out by patients who were not in the emergency room and voluntarily accepted to participate or by their legal proxies by face-to-face interview method. Results: A total of 131 patients participated in the study, and 56.5% of them were males. Average age was 46.0 +/- 17.4 years with range of 18-85. Half of patients had sufficient information for giving informed consent. 20.6 percent of patients reported that they did not have information about the disease and operation. Frequently the patients were informed by doctor after admission in the doctors' office. An approved informed consent form was found in 46.5% of patients' files but only 24.5% of them signed the form themselves. The rest were signed respectively with uncle, aunt, children or a friend. Conclusion: Our findings suggest that the informed consent procedure in our orthopedic clinic was not conducted according to national, international ethical codes, rules and regulations. Therefore it has been deduced that both updating current informed consent forms for being ethically and legally valid, and including surgical ethics to residency training will contribute to solve possible ethics problems.
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