KNOWLEDGE AND AWARENESS OF INFORMED CONSENT AMONG DENTAL PATIENTS

Obtaining informed consent from the patient is fundamental. The consent document should be in local language and should be simple and easy to understand. The awareness and knowledge on informed consent among both patients and the physician is essential in order to practice an efficient process as it is a continuous, two- way communication where transparency and partnership plays an important role.This study was undertaken to examine patients knowledge and awareness about informed consent process. 100 patients attending the Out Patient department were interviewed through questionnaire to assess the awareness and knowledge of the informed consent process. The present study revealed the percentage of patients who were aware of the informed consent process and the information provided in it.

Should medical students perform pelvic exams on anaesthetised patients without explicit consent?

There have been many reports of medical students performing pelvic exams on anaesthetised patients without the necessary consent being provided or even sought. These cases have led to an ongoing discussion regarding the need to ensure informed consent has been secured and furthermore, how it might be best obtained. We consider the importance of informed consent, the potential harm to both the patient and medical student risked by the suboptimal consent process, as well as alternatives to teaching pelvic examinations within medical school. The subsequent discussion focuses on whether medical students should perform pelvic examinations on anaesthetised patients without personally ensuring that they have given their explicit consent. Whilst we question the need to conduct pelvic examinations on anaesthetised patients in any circumstance, we argue that medical students should not perform such exams without personally securing the patients informed consent.

Surgical Decision-Making for Temporal Lobe Epilepsy: Patient Experiences of the Informed Consent Process

Background: Surgical resection is frequently the recommended treatment for drug-resistant temporal lobe epilepsy (TLE), yet many factors play a role in patients' perceptions of brain surgery that ultimately impact decision-making. The purpose of the current study was to explore how people with epilepsy, in their own words, experienced the overall process of consenting to surgery for drug-resistant TLE.Methods and Materials: Data was drawn from in-person, semi-structured interviews of 19 adults with drug-resistant TLE eligible to undergo epilepsy surgery. A systematic thematic analysis was performed to code, sort and compare participant responses. The mean age of these 12 (63%) women and seven (37%) men was 37.6 years (18–68 years), with average duration of epilepsy of 13 years (2–30 years).Results: Meeting the neurosurgeon and consenting to surgery represented an important treatment milestone across a prolonged treatment trajectory. Four themes were identified: (1) Understanding the language of risk; (2) Overcoming risk; (3) Family-centered, shared decision-making, and (4) Building decisional-confidence.Conclusion: Despite living with the restrictions of chronic uncontrolled seizures, considering an elective brain procedure raised unique and complex questions. Personal beliefs and expectations related to treatment outcomes influenced how the consent process was ultimately experienced. Decisions to pursue surgery had frequently been made ahead of meeting the surgeon, with many describing the act of signing as personally empowering. Overall, satisfaction was expressed with the information provided during the surgical visit, despite later inaccurate recall of the facts. These findings support the resultant recommendation that the practice of informed consent be conceptualized as a systematic, structured interdisciplinary process which occurs over time and encompasses three stages: preparation, signing and follow-up after signing.

Informed Consent for Intraoperative Neural Monitoring in Thyroid and Parathyroid Surgery – Consensus Statement of the International Neural Monitoring Study Group

In the past decade, the use of intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery has been widely accepted by surgeons as a useful technology for improving laryngeal nerve identification and voice outcomes, facilitating neurophysiological research, educating and training surgeons, and reducing surgical complications and malpractice litigation. Informing patients about IONM is not only good practice and helpful in promoting the efficient use of IONM resources but is indispensable for effective shared decision making between the patient and surgeon. The International Neural Monitoring Study Group (INMSG) feels complete discussion of IONM in the preoperative planning and patient consent process is important in all patients undergoing thyroid and parathyroid surgery. The purpose of this publication is to evaluate the impact of IONM on the informed consent process before thyroid and parathyroid surgery and to review the current INMSG consensus on evidence-based consent. The objective of this consensus statement, which outlines general and specific considerations as well as recommended criteria for informed consent for the use of IONM, is to assist surgeons and patients in the processes of informed consent and shared decision making before thyroid and parathyroid surgery.

Doctors’ knowledge regarding decision-making capacity: A survey of anesthesiologists

Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate decision-making capacity (DMC) as a prerequisite to informed consent. In determining whether a patient has sufficient DMC, anesthesiologists must draw on their knowledge of DMC. Knowledge gaps regarding DMC may result in incorrect assessments of patients’ capacity. This could translate to an informed consent process that is ethically and legally unsound. This study examined the DMC-related knowledge of anesthesiologists in a group of four university-affiliated hospitals. The findings suggest that anesthesiologists have several areas of knowledge deficiency regarding DMC and DMC assessment. These findings could inform the development of undergraduate and postgraduate curricula.

P-OGC64 High Fidelity Patient-Reported Outcome Monitoring following Upper Gastrointestinal and Hepato-Pancreato-Biliary Cancer Surgery. Early Experience with a Novel Application

Background Patients undergoing complex upper-gastrointestinal and hepatopancreatobiliary resections experience a high incidence of post-operative symptoms. There is significant scope to expand clinicians’ understanding of longitudinal symptom progression and recognise a greater range of post-operative symptoms than those traditionally recorded. By identifying symptoms most troublesome to patients we anticipate improvement in patients’ symptom management, the surgical consent process and, ultimately, patient experience. The myICUvoice application provides patients with the opportunity to report symptoms across a wide range of domains in real-time. We report our early experience using this application with patients in the post-operative setting. Methods Following institutional governance approval, consecutive patients undergoing pancreatic, or hepatic (H) or oesophagogastric (U) resectional surgery during a four week period at a single tertiary centre were offered the opportunity to use the application. From day-1 post-op to discharge, each patient completed surveys at least twice daily, reporting their experience across a list of 34 symptoms together with pain, breathing, mood and physical state. Both individual and cohort time-series data were obtained for each symptom and stratified by resection type. A dashboard has been developed as part of the application to allow summary data to be easily displayed. Results 342 symptom surveys were completed by a total of 15 patients (5U, 10H). The median length-of-stay was 11-days and 91% of patients completed 2 surveys/day (Table-1). High frequency symptoms were tiredness (reported in H:80%;U:86% of surveys), dry mouth (14/15 patients, H:91%,U:59%) and uncomfortable position (13/15 patients, H:27%,U:43%). Whilst most patients remained happy, there were frequent reports of psychological distress; 53% reported nightmares (H:6%,U:12% of surveys), 67% felt depressed, (H:12%,U:6% of surveys) and 53% anxious (H:14%,U:6% of surveys). Pain statement analysis (Figure-1) revealed distinct profiles providing high resolution data on the efficacy of analgesic regimes/techniques. Conclusions As expected, our patient cohort experienced a wide range, and high frequency, of post-operative symptoms. Experience conducting symptom surveys demonstrated a high incidence of disconnect between clinical expectations and reported symptoms. Our data illustrate the value of detailed symptom monitoring and this application could be used routinely to measure and improve the patient experience. Further research is planned to compare the performance of these standardised symptom surveys to current methods of identifying symptoms. Furthermore, data from specific patient populations could better inform patient expectations of the post-operative symptoms they may experience, thus improving the surgical consent process.