Knowledge, attitude, and practice regarding informed consent among dental professionals in Madina City, Saudi Arabia: A cross-sectional study
Original Article
Hussein Koura, Ahmad A. Al-Fraidi, Wasseem Abdulhameed Alzemei
Journal of Orthodontic Science, November 2023; 12(1)
Abstract
Aim
The aim of this study was to assess the knowledge, attitude, and practice (KAP) of dental professionals regarding informed consent (IC) in Madina City.
Methods
A descriptive cross-sectional design using a self-administered questionnaire was conducted. The questionnaire was tested for validity and reliability before it was distributed using Google Forms through WhatsApp among a sample of 299 dental professionals working in Madina City. IBM Statistical Package for Social Sciences (SPSS) version 26 was used for analysis.
Results
Two-hundred ninety-nine responses were collected. Sixty percent scored less than the group average regarding knowledge, and 52% scored less than the group average regarding attitude. Regarding practice, 57% scored below the group average. Saudi dentists and those who work in the Ministry of Health (MOH) had better knowledge scores than other tested groups. Dentists working in the MOH had better attitude and practice scores than those who work in the private sector. Regarding attitude and practice, consultants achieved better scores than registrars and general dentists. More than 90% indicated that the main reason for obtaining an IC is to protect themselves from legal actions.
Conclusion
The KAP of surveyed dental professionals in Madina is suboptimal and needs improvement.

Surgical Consent in the Pediatric Age Group: Parental Perceptions Toward Legal Aspects of Informed Consent
Original Article
Madani Essa
Saudi Journal of Medicine & Medical Sciences, October–December 2023; 11(4) pp 326-331
Abstract
Background
The perceptions of parents/legal guardians may drive their decisions on providing informed consent for minors. Currently, no study from Saudi Arabia has assessed the perceptions of parents/legal guardians toward informed consent for pediatric surgical procedures.
Objective
To determine parents’ perception and understanding of pediatric informed consent for surgeries from Saudi Arabia and determining their level of participation in the decision-making process of the treatment modality.
Methods
This observational cross-sectional study was conducted among parents from the Jazan region of Saudi Arabia with at least one child aged ≤ 12 years. Three aspects of surgical informed consent were evaluated: parents’ awareness, attitude, and understanding of informed consent and its legal issues; the knowledge they sought during informed consent discussions; and parents’ opinions about their respective roles in the decision-making process for the treatment.
Results
A total of 366 responses were included in this study. More than 95% of the participants agreed that informed consent was necessary; however, 94.7% felt that regardless of their beliefs, they had to sign the form. Surprisingly, the majority (61%) believed that any relative can sign the consent form on behalf of the parents/legal guardian. Most respondents believe that pre-operative procedures (80.8%), the cost (93.9%), and the reason for the procedure and its alternatives (87.2%) should be discussed when informed consent is being sought. About 76.5% of the participants wanted to know all the information regarding the procedure; of these, 48.3% responded that they would play a role in deciding the eventual treatment modality.
Conclusion
The findings of this study indicate the need to increase knowledge regarding surgical informed consent among parents in the Jazan region of Saudi Arabia.

Family-based consent and motivation for familial organ donation in Bangladesh: An empirical exploration
Original Article
Sanwar Siraj
Developing World Bioethics, 19 October 2023
Abstract
The government of Bangladesh approved the human organ transplantation law in 1999 and updated it in 2018. This legislation approved both living-related donor and posthumous organ transplantation. The law only allows family members to legally donate organs to their relatives. The main focus of this study was to explore how Bangladeshis make donation decisions on familial organs for transplantation. My ethnographic fieldwork with forty participants (physicians and nurses, a healthcare administrator, organ donors, recipients, and their relatives) disclosed that the organ donation decision was family-based. An assessment of the relationship between religion, culture, and biomedicine leads to the conclusion that deciding on donating organs to relatives is primarily family-based and is perceived to be steeped in Islamic ethical principles and religious cultural tradition. The family-based consent and motivation for donor-recipient pair organ transplantation strengthen an altruistic environment for the family and act as the moral and legal authority that ensures ethical healthcare outcomes for Bangladeshis.

Examining the adequacy of preoperative informed consent in a developing country: Challenges in the era of surgical specialisation
Ede O, Obadaseraye OR, Anichi I, Mbaeze C, Udemezue CO, Basil-Nwachuku C, Madu KA, Iyidobi EC, Anyaehie UE, Nwadinigwe CU, Ngwangwa C, Adetula UE
Developing World Bioethics, 9 October 2023
Abstract
Preoperative informed consent is a legal and ethical requirement that ensures patients understand a procedure, its associated risks and benefits, alternative treatment options, and potential complications to make an informed decision about their care. This cross-sectional study evaluated the informed consent process for major orthopaedic surgeries at a tertiary hospital in Nigeria. A self-administered questionnaire was used to collect data from 120 adult participants. Results showed that many patients do not read the consent form before signing it, and surgeons do not adequately explain the alternatives to surgery, potential risks, and available anaesthetic options. Higher-educated patients are more likely to read the consent form. Surgeons performed well in explaining the nature of the condition and prognosis, the procedure’s potential benefits, and answering patients’ questions. The study emphasises the need to improve the informed consent process to ensure patients understand and can make rational decisions about their healthcare.

Effects of the Informed Health Choices secondary school intervention: A prospective meta-analysis
Faith Chesire, Michael Mugisha, Ronald Ssenyonga, Christopher J. Rose, Allen Nsangi, Margaret Kaseje, Nelson K. Sewankambo, Matt Oxman, Sarah E. Rosenbaum, Jenny Moberg, Astrid Dahlgren, Simon Lewin, Andrew D. Oxman
Journal of Evidence-Based Medicine, 21 September 2023
Abstract
Aim
The aim of this prospective meta-analysis was to synthesize the results of three cluster-randomized trials of an intervention designed to teach lower-secondary school students (age 14–16) to think critically about health choices.
Methods
We conducted the trials in Kenya, Rwanda, and Uganda. The intervention included a 2- to 3-day teacher training workshop, digital resources, and ten 40-min lessons. The lessons focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥9 of 18 multiple-choice questions answered correctly). We performed random effects meta-analyses to estimate the overall adjusted odds ratios. Secondary outcomes included effects of the intervention on teachers.
Results
Altogether, 244 schools (11,344 students) took part in the three trials. The overall adjusted odds ratio was 5.5 (95% CI: 3.0–10.2; p < 0.0001) in favor of the intervention (high certainty evidence). This corresponds to 33% (95% CI: 25–40%) more students in the intervention schools passing the test. Overall, 3397 (58%) of 5846 students in intervention schools had a passing score. The overall adjusted odds ratio for teachers was 13.7(95% CI: 4.6–40.4; p < 0.0001), corresponding to 32% (95% CI: 6%–57%) more teachers in the intervention schools passing the test (moderate certainty evidence). Overall, 118 (97%) of 122 teachers in intervention schools had a passing score.
Conclusions
The intervention led to a large improvement in the ability of students and teachers to think critically about health choices, but 42% of students in the intervention schools did not achieve a passing score.

Counseling, informed consent, and debriefing for cesarean section in sub-Saharan Africa: A scoping review
Faysal S, Penn-Kekana L, Day LT, Tripathi V, Khan F, Stafford R, Levin K, Campbell O, Filippi V
International Journal of Gynaecology and Obstetrics, 12 September 2023
Abstract
Background
Counseling as part of the informed consent process is a prerequisite for cesarean section (CS). Postnatal debriefing allows women to explore their CS with their healthcare providers (HCPs).
Objectives
To describe the practices and experiences of counseling and debriefing, the barriers and facilitators to informed consent for CS; and to document the effectiveness of the interventions used to improve informed consent found in the peer-reviewed literature.
Search strategy
The databases searched were PubMed, EMBASE, PsycINFO, Africa-wide information, African Index Medicus, IMSEAR and LILACS.
Selection criteria
English-language papers focusing on consent for CS, published between 2011 and 2022, and assessed to be of medium to
high quality were included.
Data collection and analysis
A narrative synthesis was conducted using Beauchamp and Childress’s elements of informed consent as a framework.
Main results
Among the 21 included studies reporting on consent for CS, 12 papers reported on counseling for CS, while only one reported on debriefing. Barriers were identified at the service, woman, provider, and societal levels. Facilitators all operated at the provider level and interventions operated at the service or provider levels.
Conclusions
There is a paucity of research on informed consent, counseling, and debriefing for CS in sub-Saharan Africa.

Informed Consent and Ethical Considerations in Assisted Reproductive Technology in Nigeria: Options and Challenges
Book Chapter
Folakemi O. Ajagunna
Reproductive Health and Assisted Reproductive Technologies In Sub-Saharan Africa, 29 August 2023 [Springer]
Abstract
Informed consent, permission given by a patient in full knowledge of the consequences, risks or potential benefits of the medical procedure to be carried out is a sine qua non in the practice of Assisted Reproductive Technologies. This permission emanates from the right to autonomy which a patient should enjoy. Implicit within this right to informed consent is that the patient is given adequate information about the treatment he or she is to be subject to. Where informed consent is not obtained, it could result in jeopardy for both the medical practitioner and the patient. This chapter examines issues emanating from informed consent in assisted reproduction in Nigeria. It adopts a socio-legal approach to interrogate the practice of informed consent in Nigeria. In-depth and key-informant interviews were conducted with IVF doctors, embryologists and women patronising IVF clinics to ascertain practices in various IVF clinics in Nigeria. The research found that although there are guidelines on informed consent in the rules of professional conduct in Nigeria, this is not a true reflection of what obtains in the ART industry. The research recommends that in addition to the rules or ethos of the medical profession in Nigeria, a legal framework is essential to advance the rights of patients to full and adequate information in assisted reproduction.

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.