Issues concerning consent in patients undergoing cardiac surgery—the need for patient-directed improvements: a UK perspective

Abstract

Aims: To determine the extent to which informed patient consent for cardiac surgery corresponds with standard guidelines and to assess patient satisfaction with the consent process.

Methods: A questionnaire developed in accordance with consent guidelines published by the Medical Defence Union (MDU) and the Practicalities Of Producing Patient information (POPPi) Guide was administered to 82 patients after they were consented for cardiac surgery.

Results: Patients were informed about i) type of operation [n=80, 97.5%] ii) reason for surgery [n=78, 95%] iii) surgical procedure [n=77, 94%] iv) length of hospital stay [n=73, 89%] and v) post-surgical care [n=79, 96.3%]. However, a decreasing number of patients were notified about i) possible risks of surgery [n=64, 78%] and ii) consequences of no surgery [n=62, 75.6%]. Interestingly, patients received less adequate information about i) alternative methods of treatment (n=34, 41.4%], ii) future lifestyle (n=55, 67%] and iii) medications following surgery [n=40, 48.7%]. 81% (n=67) were overall ‘satisfied’ with the information provided. More than 95% (n=78) patients were invited to ask questions. The most commonly asked questions were about i) quality of life ii) length of operation and hospital stay iii) surgical procedure iv) consequences of no surgery.

Conclusions: The study has highlighted areas of informed consent in cardiac surgical patients that need attention. Although, patients were generally satisfied and well informed about the procedure, less information was presented covering alternative treatments, future lifestyle and medications. This was reflected in the questions asked by patients and their suggested improvements for the consent procedure.

Introduction

Patient autonomy and the importance of informed consent have been given great emphasis in recent years. This concept has become an important part of surgical practice. Furthermore, there has been a change in the attitude of society towards the surgical profession, and increasing public awareness of the issues regarding informed consent. The clinician’s obligation to obtain a patient’s consent to treatment is grounded in the ethical principles of patient autonomy and respect [1]. Indeed, as Hippocrates stated: “I will ensure patients receive the information and support they want to make decisions about disease prevention and improvement of their health” [2]. The Bristol Inquiry Report [3] recommended that there must be transparency and openness in the procedures involving public and patients, highlighting a key principle of informed consent. Our study, therefore, aimed to determine the extent to which the consent is informed, in line with standard guidelines, and to assess patient satisfaction with the consent process for cardiac surgery.