Surgical Informed Consent in Clinical Practice: Patients’ Perspective Undergoing Cesarean Section at Three Teaching Hospitals in Addis Ababa, Ethiopia
Eskinder Kebede, Tadios Tasew, Dawit Worku
Ethiopian Journal of Health Sciences, 17 August 2023
Abstract
Background
Informed consent is a communication process of providing the patient/parents/guardians with relevant information regarding the diagnosis and the treatment so that they can make informed decisions. This study was to assess the practice of surgical informed consent  in Addis Ababa.
Methods
An institution-based cross-sectional study was undertaken in Addis Ababa in 2021. A total of 312 women who underwent cesarean section were interviewed immediately after their hospital discharge.  Thirteen components of SIC were used based on international recommendations, including the Royal College of Surgeons’ standards of informed consent practices for surgical procedures.
Results
Almost all (100 %) of the respondents were asked to provide written consent, and 96.2 % of them signed the consent form. Most women (89.4%) received information about the indication(s). Few (18.6%) respondents were informed about the type of anesthesia to be administered while only 9 %( n= 28) of them were given an opportunity to choose the option of anesthesia.  Only 44.9% of the respondents have received at least six of the 13 components of SIC suggested by the investigators. In this, the most secured data was the signature of the patient which is 96 %. The least documented element of SIC was alternative treatment.
Conclusion
A majority of women who underwent both elective and emergency cesarean section did not receive comprehensive information during the Surgical Informed Consent process in the study hospitals. There is a need that patients need to be counseled during antenatal visits, specifically when patients visit near term for antenatal checkups.

Knowledge and perception of surgical informed consent among adult surgical patients in Arba Minch and Jinka General Hospitals, Southern Ethiopia
Tigabu Daniel, Yonas Abera, Menaye Yihune
Ethiopian Medical Journal, 4 August 2023
Open Access
Abstract
Background
The surgical informed consent process and format are not uniform nationally and internationally. The objective of this study was to assess the knowledge and perception of adult patients towards the legal nature of surgical informed consent in Arbaminch and Jinka General Hospitals, South Ethiopia.
Methods
Responses from 423 post-operative adult surgical patients were taken using pretested structured interviewer-administered questionnaires for five months. A hospital-based cross-sectional study of all adult surgical patients who were operated were involved before discharged from December 1 2021-April 30, 2022 in Arbaminch and Jinka general hospitals, Southern Ethiopia. Stratified sampling technique was used. The collected data entered into EPI-data version 3.1 and exported to SPSS (version 25) software for statistical analyses. A significant level was determined at a P-value <0.05 with 95% confidence interval.
Results
A total of 423 adults with a response rate of 100% were included in the study. Of the respondent’s consent, only 210 (49.6%) was taken by an operating surgeon, and the majority was taken by a general practitioner, nurse, and midwife. Surprisingly consent taken by the porter was 5(1.2%). Of the respondents, only 188(44.4%) had good knowledge and only 58 (13.7%) had a good perception regarding surgical informed consent.  Patients exposed for consent signing previously, had 4.06 times higher knowledge than those unexposed (AOR=4.06, 95% CI 😦 1.80, 4.492)). Those patients living in an urban area were well aware of surgical informed consent (AOR=0.246, 95% CI:- (0.212, 1.660)). Level of understanding of surgical informed consent, significantly increased for those informed by an operating surgeon (AOR=4.45, 95% CI:- (  1.95, 5.09)).
Conclusion
Majority of our patients had poor knowledge and poor perception regarding the legal nature of surgical informed consent. Living in urban, signing informed consent previously and consent taken by operating surgeon affected level of knowledge positively. The consent had to be taken at least by the operating surgeon.

Experiences of patients and next of kin on informed consent process for emergency surgery in two Urban university teaching hospitals in Uganda: a comparative cross sectional study
Research
Olivia Kituuka, Erisa Mwaka, Ian Munabi, Moses Galukande
BMC Emergency Medicine, 2 August 2023; 23(82)
Open Access
Abstract
Informed consent for emergency surgery is a process in which a patient or their next of kin must make quick decisions required for surgery in a life-threatening situation or surgery that may have life-altering outcomes. The objective of the study was to describe patients and their next of kin experiences and factors influencing the informed consent process in two urban university teaching hospitals in Uganda.
Methods
A cross-sectional survey involving patients who underwent emergency surgery and their next of kin was conducted in two tertiary care hospitals; one public and one private-not-for profit institution. A questionnaire was administered to collect sociodemographic information, type of Surgery that was done, how informed consent was obtained and experiences and expectations from the informed consent process. Univariate and multivariate analyses of the variables was done.
Results
We collected data from 210 patients from a public hospital and 170 from a private-not-for profit hospital. Overall, most patients did not have the risks of the surgery communicated to them (79.7%), were not given alternative options (87.6%) and had no opportunity to ask questions (57.4%). Patients at the private institution had 3.35 times the odds of expecting the consent form to be explained to them than those at the public institution. Patients at the public hospital had 0.12 times the odds of preferring to have consent administered by a nurse than patients at the private institution OR 0.12 (0.05–0.29, p < 0.001). Patients in the public institution had 0.18 times the odds of preferring to have consent administered by a doctor than patients in the private institution OR 0.18 (0.08–0.45, p < 0.001).
Conclusion
Patients in both public and private institutions are not informed about the risks of surgery, alternative options and are not given the opportunity to ask questions. Interpretation of the findings of this study on patient preferences on who administered consent though statistically significant were inconclusive due to the responses not being mutually exclusive.

Consent through art: a critique of a visual method developed with peer-researchers in southern Nepal
Joanna Morrison, Awantika Priyadarshani, Abriti Arjyal
International Journal of Social Research Methodology, August 2023
Abstract
Obtaining informed consent can be challenging during peer research when the boundaries between researcher and participant are blurred. We developed a novel visual consent method with illiterate artists in Nepal who conducted peer interviews in their communities. Artists discussed and sketched images related to ethical principles to create a visual consent form. This improved comprehension about research ethics and developed the confidence of artists to conduct peer interviews, but we found that artists memorised the form; they did not engage participants in looking at the pictures with them; and they did not use the pictures that they disagreed with. In future research, the visuals should be developed in consultation with participants and be used to explain the study to participants. The tool development process can be used to establish a joint understanding about the research, its harms, and benefits, and to develop relational and iterative consent processes in participatory action research.

An examination of the moral conundrum of informed consent within the framework of African values and belief systems : a case study
Jamila Kathoon Adam, Francis Fabian Akpa-Inyang
Interdisciplinary Journal of Economics and Business Law, 2023; 12(1)
Abstract
The notion of bio-medical ethics, which places a strong focus on individual autonomy when considering informed consent, is mostly inspired by western European medical and moral traditions, leaving African traditions and values out of the practice of medical ethics. This is due to the fact that African customs and values favour communitarianism above individualism. In African culture, your strong relationships with people in the community which include sharing everything, including decision-making are what define you as a human being. As a result, it is clear that when applied to the majority of Africans, the idea of individual liberty in informed consent is inapplicable. This is because African communitarian ethics focuses on the interests of the family, community and society and not the individual. Thus, there might be a conflict in the application of the western principle of medical ethics in the general population in Africa. This review paper intends to use published articles, reports, case studies, and ethical principles to explore this potential conflict.

Accessibility of the consent form in Brazilian clinical research
Research
Renan Emilio Kintopp, Sergio Surugi de Siqueira, José Eduardo de Siqueira, José Humberto Guerreiro Tavares Fregnani
Revista Bioética, 2023
Abstract
The informed consent form informs clinical research patients about the nature of the research and their rights, formalizing their decision to participate; however, studies show that this document is written in a complex manner, compromising patient autonomy. Two consent forms from the same hypothetical research were developed with different writing styles and analyzed by the Coh-Metrix Port tool, which evaluates linguistic metrics and textual accessibility. Results showed that both texts were complex and required high schooling level to be understood. These findings reinforce the perception that consent forms may have their real function compromised and point to the importance of changing its elaboration.