Patients Perception of the Quality of Consent for Caesarean Sections in Tertiary Health Facility in Port Harcourt, Southern Nigeria
Kenneth Eghuan Okagua, Joyce Okagua
The Nigerian Health Journal, 2019; 19(4)
Open Access
Abstract
Background
Informed consent should be viewed as a process and not just a signature on a form as is commonly seen in most cases. It is very important not just to minimise conflict/medico-legal issues but as a tool for better communication between the physician and the patient on diagnosis, treatment risk, etc. In order to improve acceptance/minimise conflicts from Caesarean Deliveries, which are increasingly being performed globally, it is important to determine patients perception of the quality of consents obtained, more so, as previous studies have demonstrated poor quality of consent for various surgical procedures.
Materials and Method
A cross-sectional study was carried out in Braithwaite Memorial Specialist Hospital, between January 2016 to June 2016, using an interviewer based structured questionnaire on women who had caesarean section.
Results
Three hundred and forty eight women who had caesarean section were recruited for the study. They were aged between 20 and 42 years with a mean age of 31.74 ± 4.39 years. Majority (67.5%) of the women had tertiary level of education and 94.8% of the women were married. Of the 348 women, 220 (63.2%) had emergency caesarean section. 89.9% had knowledge of the diagnosis and the same number, were not aware of possible complications. 55.7% of the consents were obtained by a nurse. Only 52% of the women were satisfied with the consent.
Conclusion
The quality of consent for obstetric surgeries is still poor. Doctors especially consultants need to be more involved in the process to improve its quality.

Level of education and preferred language of informed consent for clinical research in a multi-lingual community
Grace Muzanyi, Isaac Sekitoleko, John L Johnson, Jane Lunkuse, Gladys Nalugwa, Joanita Nassali, David Kaawa Mafigiri
African Health Sciences, June 2020; 20(2)
Open Access
Abstract
Background
Low education levels and language barriers present challenges in obtaining informed consent for clinical research.
Objective
To describe and correlate the association between the level of education and the participant’s preferred language of consent.
Design
Descriptive-analytical cross-sectional study.
Participants
Adults being consented for participation in tuberculosis (TB) research studies in an East African community with varying levels of education.
Procedures
We analyzed data on demographic and educational characteristics collected from adults being consented for participation in TB studies. Only participants who could understand and speak Luganda (the main local language) or English (the official language of Uganda) were included in this analysis.
Results
A total of 523 participants were consented between April 2015 and December 2017 and included in this analysis; 250 below Senior four ( 13yrs of education). We noted that the preference for English rises with the rising levels of education and peaked at beyond senior six (83%Vs17%,OR=49,95%CI:22.8-106.3,p<0.001).Participants below senior four preferred Luganda Vs senior four and above(OR=16.9,95%CI:9.9-28.8,p<0.001)
Conclusion
Rising education levels of participants were associated with preference for English language usage during initial consent for clinical research studies.

Egyptians’ social acceptance and consenting options for posthumous organ donation; a cross sectional study
Research Article
Ammal M. Metwally, Ghada A. Abdel-Latif, Lobna Eletreby, Ahmed Aboulghate, Amira Mohsen, Hala A. Amer, Rehan M. Saleh, Dalia M. Elmosalami, Hend I. Salama, Safaa I. Abd El Hady, Raefa R. Alam, Hanan A. Mohamed, Hanan M. Badran, Hanan E. Eltokhy, Hazem Elhariri, Thanaa Rabah, Mohamed Abdelrahman, Nihad A. Ibrahim, Nada Chami
BMC Medical Ethics, 15 June 2020; 21(49)
Open Access
Abstract
Background
Organ donation has become one of the most effective ways to save lives and improve the quality of life for patients with end-stage organ failure. No previous studies have investigated the preferences for the different consenting options for organ donation in Egypt. This study aims to assess Egyptians’ preferences regarding consenting options for posthumous organ donation, and measure their awareness and acceptance of the Egyptian law articles regulating organ donation.
Methods
A cross sectional study was conducted among 2743 participants over two years. Each participant was required to rank eleven consenting options from 1 (most preferred) to 11 (least preferred), and to report his awareness and acceptance of the seven articles of the Egyptian law of organ donation.
Results
47% of the participants expressed willingness to donate their organs after death. This percentage increased to 78% when consenting options were explained to participants. “Informed consent by donor only” was the most preferred type of consent for one third of respondents. Awareness of the law articles regulating organ donation was relatively low ranging from 56% to 23%.
Conclusion
Currently, around half of the Egyptian population agree to posthumous organ donation. This percentage could be increased significantly by raising the awareness about how the process of donation could be regulated and how the patient’s right of decision could be protected.

Empirical Investigation on the Contents of the Patients Informed Consent Forms for Medical Imaging Services in the Government Hospitals in Nairobi City County, Kenya
Victoria Otysula Koi, Dr. Andrea Yitambe, Dr. Peterson Warutere
International Academic Journal of Health, Medicine and Nursing, 5 June 2020; 2(1) pp 66-79
Open Access
Abstract
Informed consent is a requirement by the law to allow patients to make decisions with respect to their health and well-being. It is an ethical and legal requirement that patients seeking medical imaging services should give an informed consent prior to seeking treatment with respect from healthcare providers. However, the extent of usage of the informed consent process vary across medical procedures. The study therefore seeks to assess the contents of the patients Informed Consent Forms for medical imaging services in the government hospitals in Nairobi City County, Kenya. The study adopted a descriptive cross-sectional study design. The study specifically focused on administration of informed consent, contents of the patients Informed Consent Forms and modes of informed consent used among patients for medical imaging services. Imaging departments in Kenyatta National hospital, Mbagathi, Mama Lucy, National spinal injury and National Mathare Hospitals in Nairobi City County were chosen as the area of study. Patients in the imaging departments of the selected hospitals were recruited for study. The sample size selected was 307 respondents. The respondents were selected using systematic random sampling at a predetermined interval of 3. Collected data was coded for analysis by use of SPSS. Analysis was conducted on descriptive and inferential statistics. Frequency tables, pie charts and graphs were used to present the quantitative data. Inferential statistics were done using Chi Square tests to determine the association between study variables at 95% confidence interval (p<0.05). The ethical considerations were strictly followed during data collection. It was further revealed that age (χ2=3.782; df= 4; p=0.016;), level of education (χ2=3.89; df= 4; p=0.030), revelation of reason for referral (χ2=26.081; df=1; p=0.001), provision of right to refuse or defer imaging (χ2=33.468; df= 1; p=0.001), giving consent for treatment (χ2=70.733; df=1; p=0.001), decision making for wellbeing (χ2=12.056; df=1; p=0.001), preoperative counseling (χ2=9.533; df=1; p=0.002), cases of negligence from clinicians (χ2=22.414; df=1; p=0.001), understanding information provided by clinicians (χ2=4.394; df=1; p=0.036), adaptation of informed consent doctrine meeting physicians and patients (χ2=7.648; df=1; p=0.006), performance of diagnosis from patients’ past medical history (χ2=9.788; df=1; p=0.002), advice on alternative treatment options available (χ2=8.065; df=1; p=0.005), disclosure of information by practitioners (χ2=19.406; df=1; p=0.001) and physical examination done before medication (χ2=9.006; df=1; p=0.003) were significantly associated with informed consent administration among respondents. The study concludes majority of the domains of the contents of informed consent had a significant statistical association with administration of informed consent among respondents. These research findings provide a great insights and information to leaders, managers, law makers, governing and oversight authorities in decision making, policy formulation, strategic planning and regulation in a context specific to provide a conducive environment for practicing medical imaging procedures in an ethical and legal manner.

Examination of Informed Consent Forms in Masters and Doctorate Theses of Educational Sciences
Ozgur Onen, Funda Eryilmaz Balli
International Online Journal of Educational Sciences, May 2020; 12(2) pp 119-131
Abstract
The purpose of this study is to examine the informed consent forms of the master’s theses and doctorate dissertations in educational sciences departments in Turkey; and to reach a conclusion about whether the informed consent forms have the related informed consent criteria (competence, voluntariness, disclosure, recommendation, understanding, decision and authorization) as proposed by previous studies. This study is designed as documentary analysis, and the data was obtained from master and doctorate theses which have been approved by social sciences and educational sciences institutions, and submitted to the National Theses Center founded by the Council of Higher Education (CoHE). Results indicated some deficiencies on consent forms, and some studies even did not report consent forms in master thesis and doctorate dissertations. The results of the study are discussed in the light of the existing literature. Finally, for ensuring responsible research conduct, some recommendations were provided.

Knowledge about informed consent among doctors in postgraduate courses in Bangladesh
Original Article
Kazi Taib Mamun, Nabeela Mahboob, Mohammad Abdullah Al Mahmud, K. Zaman
Ibrahim Medical College Journal of Medical Science, 7 March 2020; 14(1)
Open Access
Abstract
Background and objectives
Informed consent is now accepted as the cornerstone of medical practice and research. Concept of consent is an endeavor by which the patient can take part in clinical judgment concerning their treatment and protects patient and doctors against any litigation. However, in research informed consent is not merely a form that is signed, but is a process in which the participant has an understanding of the research and its risks. In view of this, the objective of the study was to assess the knowledge regarding informed consent among the doctors pursuing postgraduate courses in a medical institute in Bangladesh.
Methodology
A descriptive cross sectional study was carried out among 160 postgraduate medical students in Dhaka city. A self-administered structured questionnaire consisting of 36 questions was used to assess their knowledge regarding informed consent. The response format was based on a 3-point Likert scale. Frequency distribution was used for statistical analysis.
Results
The age range of the participants was from 25-40 years. Of the total participants, 48% were males and 42% were females. Majority of the respondents acknowledged the importance of an informed consent and 86.3% of the doctors agreed that only verbal consent was not adequate. Only 66.2% agreed that consent for participation in research should always be voluntary and informed. Majority (76.9%) agreed not to recruit individuals with mental or behavioral disorders not capable of giving adequately informed consent. Only 27.5% were aware that assent should be taken from children participating in a research. Out of total participants, 71.2% and 81.2% agreed that the participants should be informed about the laboratory test results. Management/referral must be ensured in case of abnormal test results respectively. For genetic research, 88.1% and 81.3% agreed for pre- and post-counseling respectively.
Conclusion
There is need to initiate further educational programs to aware the doctors of the importance of informed consent in research, clinical practice and patient care.

Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia
Research Article
Ghiath Alahmad, Sarah Aljohani & Muath Fahmi Najjar
BMC Medical Ethics, 12 May 2020; 21(35)
Open Access
Abstract
Background
With the huge number of patients who suffer from chronic and incurable diseases, medical scientists continue to search for new curative methods for patients in dire need of treatment. Interest in stem cells is growing, generating high expectations in terms of the possible benefits that could be derived from stem cell research and therapy. However, regardless of the hope of stem cells changing and improving lives, there are many ethical, religious, and political challenges and controversies that affect the research, and mandated to establish ethical guidelines and regulations. In Saudi Arabia, key stakeholders play an active role in discussing the ethics of stem cell research and therapy. The focus of the study was to explore professionals’ perceptions related to the ethical challenges of using stem cells in research and treatment in Saudi Arabia.
Results
A qualitative research study was conducted to explore and describe the perceptions of 25 professionals employed at different tertiary hospitals in the various regions of Saudi. A thematic analysis was performed to search for and identify the most significant perceptions shared by the participants. Four themes were generated based on the ethical challenges of four areas related to stem cell use, including (1) forbidden and permitted sources of stem cells, (2) informed consent, (3) beneficence, and (4) ethical regulations and guidelines.
Conclusion
The study identified that there is a growing need to advance the knowledge, education, and awareness related to stem cell research and treatment in Saudi Arabia.

Material risk: a review of informed consent in the UK
Thomas Walton
Orthopaedics and Trauma, 24 April 2020
Abstract
Consent is a requirement for any medical or surgical intervention to be deemed appropriate. For such consent to be considered valid, it must be given voluntarily, by an individual with capacity, who has the appropriate information available to make an informed decision in line with their values. Following the Montgomery vs. Lanarkshire ruling in 2015, the legal basis from which informed consent is measured has changed. The law now reflects pre-existing professional guidelines, and advocates a patient-centred approach to informed consent. The previously paternalistic focus of informed consent, whereby it was deemed a matter for clinical judgement, has been firmly abandoned in favour of the provision of information pertaining to ‘material risks’, as determined by the significance attached to these risks by the patient themselves. This paper serves to provide an overview of consent within the medical profession, and gives an account of the implications of this landmark ruling.

A Review of Socio-Cultural Factors Affecting Patients’ Right to Informed Consent and Autonomy in Medical Practice in Nigeria
Chinemelum Nelson Arinze-Umobi, Godwin N Okeke
African Journal Of Law And Human Rights, 2020; 4(1)
Open Access
Abstract
Today, the fundamental principle of medical law and ethics is that a medical professional should obtain the informed consent of a competent patient before administering any form of treatment on such a patient. This is in tandem with the principle of autonomy (self-determination) which is intrinsic in every individual save for circumstances wherein the observance of this principle can legally be departed from. In clinical context, ‘autonomy’ connotes a patient’s ‘right to refuse and right to participate in every decision regarding medical treatment’. This study reviewed the socio-cultural factors inhibiting patients’ right to autonomy in medical practice in Nigeria. The study found that striking a balance between the opposing interests may be a difficult tasks as patients’ right to autonomy is case-specific and that a whole lot of factors operate in the social space and as a result, alter, from time to time, the standard, such that it becomes nearly impossible to apply the same standard in all instances. The study found that certain circumstances exist in the doctor-patient relationship wherein a patient lacks capacity to grant such consent to the medical professional – hence the need for such consent to be given on his/her behalf towards his/her best interests.