Doctors' Perspectives of Informed Consent for Non-Emergency Surgical Procedures: a Qualitative Interview Study

Fiona Wood, Cardiff University
Sean M. Martin, Cardiff University
Andrew Carson-Stevens, Cardiff University
Glyn Elwyn, Dartmouth College
Elizabeth Precious, Cardiff University
Paul Kinnersley, Cardiff University


BackgroundThe need to involve patients more in decisions about their care, the ethical imperative and concerns about ligation and complaints has highlighted the issue of informed consent and how it is obtained. In order for a patient to make an informed decision about their treatment, they need appropriate discussion of the risks and benefits of the treatment. ObjectivesTo explore doctors' perspectives of gaining informed consent for routine surgical procedures. DesignQualitative study using semi-structured interviews selected by purposive sampling. Data were analysed thematically. Setting and ParticipantsTwenty doctors in two teaching hospitals in the UK. ResultsDoctors described that while consent could be taken over a series of consultations, it was common for consent to be taken immediately prior to surgery. Juniors were often taking consent when they were unfamiliar with the procedure. Doctors used a range of communication techniques to inform patients about the procedure and its risks including quantifying risks, personalizing risk, simplification of language and use of drawings. Barriers to effective consent taking were reported to be shortage of time, clinician inexperience and patients' reluctance to be involved. Discussion and ConclusionCurrent consent processes do not appear to be ideal for many doctors. In particular, junior doctors are often not confident taking consent for surgical procedures and require more support to undertake this task. This might include written information for junior staff, observation by senior colleagues when undertaking the task and ward-based communication skills teaching on consent taking.