Evaluation of The Content of Preoperative Consent and Its Application in Karbala Maternity Hospital in 2012; A Descriptive Cross-Sectional Study

Abstract

The art of medicine and treating the other human is a complex issue consists of three elements those are (DOCTOERS, PATEINTS ,DISEASE) for long time the physicians use the medics and knife as only tool to treat their patient and forgotten that there was third tool to be used which is communications with patients . Nowadays, informed consent has replaced the old paternalistic notion of “the doctor knows best”, with a more collaborative patient-physician relationship. Objectives: To evaluate the content and comprehensiveness of informed preoperative consent from patient and physician view, Express the important of the patient commitments to giving the pre-operative consent, Find out the effect of patient acknowledgment with pre-operative form on their consent and effect on the operation rates, To measure the level of doctor commitment to explain the preoperative form for their patients and the level of explanation given to them Methods and Data Collection: A descriptive cross sectional study was carried out from first of august to 31 of december of 2012 . The sample 103 patient was extracted from patients, operated by different Obstetricians (working at Karbala Maternity Hospital).We developed two types of questionnaires(one for patients and other for the doctors) The questionnaire consists of several items organized in four parts: 1) The demographic data 2)The obstetric information 3) informed consent knowledge and 4) post interviewing data.Specialist obstetrician explained the purpose of the study to each patient atthe second postoperative day asked for her consent to be included in the study and to complete the questionnaire and to explain the form of consent found in patient file and the suggested informed consent that developed according the guideline of the WHO and universal consensual by different academic associations..The Chi square test was used tocompare the results Differences with a p value <0.05 were considered statistically significant. Results and Discussion:In total, 103 patients operated by different surgeons, volunteered to respond to the questionnaire. Most of them were in 26-35 years age group.About 58.3% % of patient have previous surgery one or more , of them 51% they did not know about the consent form at all . About 92% haven’t read the consent form. 99% of patients have understood the concept of consent just after we read the consent form ,while 100% of them agreed that they understood the consentmore after explanation . 84% of patients agreed that the consent should be changed. Regarding the response of the surgeons in the hospital there is mismatch between their answers and the patient answer about any explanation preoperatively ,43% of surgeons did not see the patient signature on consent form preoperatively , 61.9% not sure that their patient signed by themselves on the consent form 33.3% of surgeons preoperative don’t give any information to the patient most of them state that is not their duty,23.8% 0f surgeons don’t share their patients in decision making, 43% of surgeons face problem with patient and family , 44% of these problems because of communications about 90% of them answer that we can prevent these problem by good informed consent ,53% of surgeons faced a patient who refused to do the operation after the consent only 33% of surgeons attended course about informed consent . Conclusion and recommendations: unfortunately we haven't any protocol or education programs about preoperative informed consent and its follow-up by both surgeons and patients so we recommend to initiate those protocols and programs and more courses to train the doctors and medical staff and administrative staff about those protocols . and to change the consent form to approved one.