Adherence to General Medical Council guidance regarding disclosure of alternative treatments during the consent process

Adherence to General Medical Council guidance regarding disclosure of alternative treatments during the consent process
Conference Presentation
George S Bethell, Robert A Wheeler, Nigel J Hall
69th British Association of Paediatric Surgeons Annual Congress, 21-23 June 2023; Bruges
Abstract
Introduction
General Medical Council (GMC) guidelines dictate that reasonable alternatives to treatment should be disclosed during the consent process. We aimed to determine if GMC guidelines on disclosure of alternatives during consent are being followed in a real world example which is disclosure of non-operative management as an alternative to appendicectomy in uncomplicated paediatric appendicitis.
Methods
Retrospective single centre observational study and national consultant specialist paediatric surgeon survey. Two groups of 50 consecutively treated children (< 16 years) with acute uncomplicated appendicitis were included in the observational study during two time periods. UK based consultant surgeons that treat appendicitis were included in the national survey. The main outcomes were disclosure and use of NOM as an alternative to appendicectomy.
Results
Overall, in the observational study, NOM was disclosed in 30(30%) children and 77%(23/30) opted for this treatment method when it was disclosed. There were 83 survey respondents representing all 25 eligible specialist pediatric surgery centres. Ten(12%) consultants reported routinely offering NOM, 39(47%) offer it in select circumstances, and 34(41%) never offer NOM. Only 25(30%) respondents always disclose NOM as an alternative to appendicectomy, whilst 22(27%) never do. Consultants who never disclose NOM are more likely to prefer appendicectomy over NOM compared to those always disclose it(p<0.001).
Conclusion
In this illustrative clinical scenario, observed and reported practice regarding disclosure of alternative treatments during the consent process do not meet GMC guidance. This risks depriving children and caregivers of a choice that they are entitled to.