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      Análisis de los formatos de consentimiento informado en los establecimientos de salud Reflexiones bioéticas y jurídicas en el contexto peruano Translated title: Analysis of Informed Consent Forms in Public Health Facilities. Bioethical and Legal Reflections in the Peruvian Context Translated title: Análise dos formulários de consentimento informado nos estabelecimentos de saúde públicos. Reflexões bioéticas e jurídicas no contexto peruano

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          Abstract

          Resumen: en la actividad asistencial desarrollada por los profesionales de la salud, el consentimiento informado (CI) instrumentaliza la aquiescencia otorgada por el paciente respecto al procedimiento y/o intervención quirúrgica. Existe una regulación dispersa en el ordenamiento legal peruano en relación con el CI. En el ámbito del sistema interamericano se resuelven precedentes importantes que establecen el contenido mínimo que se debe informar al paciente previo al consentimiento. Se evalúo el cumplimiento de 22 elementos necesarios y nueve deseables en los formatos de CI, en atención al ordenamiento normativo vigente y a lo previsto a nivel supranacional por la Corte Interamericana de Derechos Humanos (Corte IDH). Dichas categorías fueron validadas mediante el juicio de expertos abogados y profesionales de la salud. La población objetivo estuvo conformada por 456 formatos de consentimiento aplicados en los establecimientos de salud públicos de Lima Metropolitana, durante los años 2019-2021. En todos los formatos se cumplen los elementos necesarios asociados con datos del paciente, el profesional de la salud y el nombre del procedimiento o intervención quirúrgica. No hay elemento deseable que se cumpla en la totalidad de estos formatos. En ese sentido, se advierten brechas en el contenido de los esos formatos en los establecimientos de salud peruanos, por lo que se debe reivindicar el aspecto informativo para lograr actos de consentimiento plenamente eficaces.

          Translated abstract

          Abstract: in the healthcare activity carried out by health professionals, informed consent (IC) instrumentalizes the acquiescence of the patient concerning the procedure and/or surgical intervention. There is a scattered regulation in the Peruvian legal system about IC. In the Inter-American system, essential precedents establish the minimum content the patient should be informed of before consent. Compliance with 22 necessary elements and nine desirable elements in the IC forms was evaluated under the current legal system and the supranational provisions of the Inter-American Court of Human Rights (IACHR Court). These categories were validated through the judgment of expert lawyers and health professionals. The target population consisted of 456 consent forms applied in public health facilities in Metropolitan Lima from 2019-2021. In all the formats, the necessary elements associated with patient data, the health professional, and the name of the procedure or surgical intervention are fulfilled. There is no desirable element that is fulfilled in all of these formats. In this sense, there are gaps in the content of these forms in Peruvian health facilities, so the informative aspect should be vindicated to achieve fully effective acts of consent.

          Translated abstract

          Resumo: na atividade assistencial desenvolvida pelos profissionais da saúde, o consentimento informado (CI) instrumentaliza a aquiescência outorgada pelo paciente a respeito do procedimento e/ou intervenção cirúrgica. Existe uma regulamentação dispersa no ordenamento legal peruano com relação ao CI. No âmbito do sistema interamericano, são resolvidos precedentes importantes que estabelecem o conteúdo mínimo que deve ser informado ao paciente prévio ao consentimento. Foi avaliado o cumprimento de 22 elementos necessários e nove desejáveis nos modelos de CI, em atenção ao ordenamento normativo vigente e ao previsto no âmbito supranacional pela Corte Interamericana de Direitos Humanos (Corte IDH). Essas categorias foram validadas mediante o julgamento de especialistas advogados e profissionais da saúde. A população-alvo esteve conformada por 456 formulários de consentimento aplicados nos estabelecimentos de saúde públicos de Lima Metropolitana, durante 2019-2021. Em todos os formulários, são cumpridos os elementos necessários associados com dados do paciente, o profissional da saúde e o nome do procedimento ou intervenção cirúrgica. Não há elemento desejável que se cumpra na totalidade desses formulários. Nesse sentido, são apresentadas lacunas no conteúdo desses formulários nos estabelecimentos de saúde peruanos, por isso o aspecto informacional deve ser reivindicado para conseguir atos de consentimento plenamente eficazes.

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          Most cited references55

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          The kappa statistic in reliability studies: use, interpretation, and sample size requirements.

          This article examines and illustrates the use and interpretation of the kappa statistic in musculoskeletal research. The reliability of clinicians' ratings is an important consideration in areas such as diagnosis and the interpretation of examination findings. Often, these ratings lie on a nominal or an ordinal scale. For such data, the kappa coefficient is an appropriate measure of reliability. Kappa is defined, in both weighted and unweighted forms, and its use is illustrated with examples from musculoskeletal research. Factors that can influence the magnitude of kappa (prevalence, bias, and non-independent ratings) are discussed, and ways of evaluating the magnitude of an obtained kappa are considered. The issue of statistical testing of kappa is considered, including the use of confidence intervals, and appropriate sample sizes for reliability studies using kappa are tabulated. The article concludes with recommendations for the use and interpretation of kappa.
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            The Quality of Informed Consent Forms—a Systematic Review and Critical Analysis

            Background The patient’s consent to a medical procedure must be preceded by a pre-procedure discussion with the physician that is documented on a standardized form. Evidence suggests that these forms lack information that would be relevant for an informed decision. Methods We carried out a systematic literature search up to February 2017 for evidence on the quality and efficacy of informed consent forms. The definition of criteria for the evaluation of meta-information, content, and presentation were derived from current guidelines for evidence-based health information. As an example, we analyzed consent forms currently in use in Germany for 10 medical interventions with regard to decisionally relevant content and intelligibility of format. Results Our literature search yielded 14 content analyses, which revealed that even some of the more important evaluative criteria were not always met, including information on benefits (9/14), risks (14/14), alternatives (11/14), the option of doing nothing (6/14), and numerical frequencies (2/14). All analyses indicated deficiencies in the content of the consent forms. We then analyzed 37 consent forms obtained from publishing companies (across Germany) and physician’s practices in Hamburg. These forms were found to contain information on: the intervention (37/37), benefits (30/37), risks (37/37), alternatives (26/37), the option of doing nothing (4/37), numerical frequencies (10/37), the names of the authors (17/37), sources of information (0/37), and date of issue (21/37). Conclusion Both the evidence from foreign countries and our own analysis of the consent forms now in use in Germany revealed deficiencies, particularly in the communication of risks. New standards are needed to promote well-informed decision-making. Structural changes in the process of patient information and decision-making should be discussed.
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              ANÁLISIS DE FORMATOS DE CONSENTIMIENTO INFORMADO EN COLOMBIA. PROBLEMAS ÉTICO-LEGALES Y DIFICULTADES EN EL LENGUAJE

              En Colombia, el consentimiento informado surgió en la atención médica hospitalaria, siguiendo las mismas trayectorias y recorridos de otros países, y apelando a la autonomía individual. En un comienzo se extendió a otras áreas y especialidades médicas no hospitalarias involucrando otras profesiones, sobre todo en las dos últimas décadas. Aparece fundamentalmente como una exigencia legal y básicamente como documento escrito, en el contexto de sociedades cada vez más autónomas que exigen derechos y decisiones sobre su salud, cuerpo y vida. Este escrito presenta los principales resultados de la investigación sobre formatos de consentimiento informado usados para procedimientos frecuentes en la atención en salud, en la cual se buscó determinar el cumplimiento de 28 categorías consideradas imprescindibles y 8 deseables. Categorías dadas según la normatividad colombiana en cuanto a los parámetros sugeridos a nivel internacional para documentos de consentimiento informado (CI) y la teoría en bioética. También se analizó el tipo de lenguaje utilizado en su elaboración para tratar de establecer si era experto (técnico) o cotidiano, con el objetivo de identificar dificultades respecto a la información suministrada en los documentos. Se revisó, además, la presencia o ausencia de las categorías y el uso del lenguaje en 80 formatos de uso frecuente (151 folios) de 22 instituciones (hospitales, empresas promotoras de salud (EPS) e institución prestadora de servicios de salud (IPS)), en 13 actividades clínicas diferentes.

                Author and article information

                Journal
                rlb
                Revista Latinoamericana de Bioética
                rev.latinoam.bioet.
                Universidad Militar Nueva Granada (Bogotá, Distrito Capital, Colombia )
                1657-4702
                2462-859X
                June 2023
                : 23
                : 1
                : 137-153
                Affiliations
                [1] Lima orgnameUNMSM Perú jose.angeles1@ 123456unmsm.edu.pe
                [2] Lima Estado de México orgnameUniversidad Continental Mexico mplacenciam@ 123456unmsm.edu.pe
                [3] Lima orgnameUniversidad Ramón Llull duiliofuentes@ 123456gmail.com
                Article
                S1657-47022023000100137 S1657-4702(23)02300100137
                10.18359/rlbi.6395
                d54cd6e3-4783-423a-80ce-ec80656b5cf4

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 02 August 2022
                : 26 December 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 55, Pages: 17
                Product

                SciELO Colombia

                Categories
                Artículos

                bioética,relação médico-paciente,direito à saúde,consentimiento informado,autodeterminação,consentimento informado,right to health,physician-patient relationship,bioethics,self-determination,informed consent,derecho a la salud,relación médico paciente,autodeterminación

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