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      Dissatisfaction with Consent for Diagnostic Gastrointestinal Endoscopy

      , , ,  

      Digestive Diseases

      S. Karger AG

      Ethics, Medicolegal, Consent, Endoscopy

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          Abstract

          Introduction: Little is known about patients’ perspectives on the amount of information they receive prior to diagnostic gastrointestinal endoscopies. Our unit’s policy for obtaining consent consists of initially posting an information leaflet to the patient followed by subsequent explanation of the procedure on arrival for the test. The consent form is signed by the patient immediately prior to the test. Methods: A questionnaire survey was conducted to assess patient perception and satisfaction with the amount of information received before diagnostic endoscopy. Results: The information was obtained from 127 of the 175 questionnaires that were distributed. Whereas 97% had read the information leaflet, only 52% had read the consent form before signing it. 64/127(51%) felt dissatisfied because they would have wanted more information while 3% were dissatisfied because they would have liked less information relating to one or more aspects of the test. Dissatisfaction was higher in patients who had not read the consent form (p < 0.001) and those with some formal education (p = 0.01). Conclusions: Patients who did not read the consent form were more dissatisfied. Strategies to improve the rate of reading this document may increase patient satisfaction.

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          Most cited references 4

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          Towards better informed consent in endoscopy: a study of information and consent processes in gastroscopy and flexible sigmoidoscopy.

          To determine the level of knowledge achieved by patients who have read a simple information sheet on gastroscopy and flexible sigmoidoscopy, and to determine the levels of information required by patients and solicitors specializing in clinical negligence. Self-administered questionnaires were sent to 516 patients in Leicester and 79 solicitors specializing in clinical negligence in England and Wales. The main objective outcome measures were the correct scores measured in a simple test of the content of information sheets about gastroscopy and flexible sigmoidoscopy. Other scores were based on the opinions of patients and solicitors on the type of information patients should receive and the levels of risk about which they should be informed. Of the clinical negligence specialists, 75%, compared with 44% of patients, felt that consent to procedures should be obtained 2 weeks before the test. In addition, 86% of solicitors felt that patients needed to be told about tests on at least two occasions and favoured booklets and videos. Both 48% of solicitors and 38% of patients felt that patients should be told of very uncommon risks, with 16% of clinical negligence specialists expecting patients to be told of risks of 1 in 1,000,000. The majority of patients (98%) and solicitors (95%) felt that patients should be formally tested as to whether they understand what they are told in the consent process. In an initial study of an information leaflet, South Asian patients had significantly poorer scores than English patients on formal testing of their knowledge of the leaflet's content. The poorest response (61% correct) was to a question including the word 'indigestion', which had been omitted from the information leaflet. Its inclusion led to a significant increase in the number answering the question correctly (96%). The positioning of a word in the list of reasons for doing the test was also important. In the flexible sigmoidoscopy leaflet, the word 'anaemia' was placed in the middle of a list of reasons for doing the test; only 85% answered the question correctly. In the sample of patients who received the modified gastroscopy leaflet, recall at 6 months was significantly impaired with most loss of memory being related to the purpose of the test. Consent needs to be supported by easy-to-read information and the patients' understanding needs to be formally tested. Important concepts must be included in this information as well as any uncommon risks of the procedure. In order to ensure that the information can be understood, the text should be reviewed by an experienced educationalist. If the text is to be used in a multicultural setting, it is important to ensure that patients for whom English is not their first language can easily understand it. The movement away from 'informed consent' towards an 'informed decision' process should facilitate these improvements.
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            Postal consent for upper gastrointestinal endoscopy

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              Informed consent for colonoscopy. A prospective study.

              Central to the nature of the physician-patient relationship is how fully patients are informed about their disease and prognosis and how active a role they take in deciding treatment; the "autonomy" and "paternalistic" models represent current poles of physician behavior. While informed consent has become ubiquitous in medical practice, it is not clear to what extent the value of patient autonomy has entered into everyday medical decisions. To evaluate informed consent, we prospectively surveyed 102 outpatients scheduled to undergo a colonoscopy and 16 of their physicians. The colonoscopy examination is straightforward and offers an optimal opportunity for patient participation in decision making. We found that most patients wanted guidance from their physicians and most physicians did not view the patient as autonomous. The more traditional parentalistic model continues to influence the physician-patient relationship, at least for this technical endeavor.
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                Author and article information

                Journal
                DDI
                Dig Dis
                10.1159/issn.0257-2753
                Digestive Diseases
                S. Karger AG
                978-3-8055-7529-4
                978-3-318-00933-0
                0257-2753
                1421-9875
                2002
                2002
                14 January 2003
                : 20
                : 3-4
                : 275-279
                Affiliations
                University Hospital Aintree, Liverpool, UK
                67680 Dig Dis 2002;20:275–279
                10.1159/000067680
                12577940
                © 2002 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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