The Practice of informed consent among patients undergoing major surgeries at a regional referral hospital in Dar es Salaam Tanzania

Abstract

Background: Informed consent for surgery has become a critical component in surgical practice. Patients learn about and understand the purpose, benefits and potential risks of surgical intervention and then agree to receive treatment through a well-prepared informed consent. Increased medico-legal litigation and the desire to provide patients with more say concerning their own treatment has highlighted the need to strengthen quality of informed consent in surgical procedures. This study was designed to determine the practice of informed consent among patients undergoing major surgery in surgical department at a regional referral hospital in Dar es Salaam Tanzania.

Methods: A hospital based descriptive cross sectional study was conducted at Temeke Regional Referral Hospital in Dar es Salaam Tanzania involving seventy one patients aged ≥18 years who were admitted in surgical wards and had undergone major surgical procedure from June to July 2022. Convenience sampling technique was utilized to recruit the study participants. Data collection was done by using closed ended questionnaire Swahili version and analyzed using the statistical package of social sciences (SPSS) computer software version 23.0

Results: A total of 71 patients were enrolled; males 53 (74.6 %) outnumbered females 18 (25.4%). There were more emergency surgeries (52.1%) than elective surgeries (47.9%). Most participants (69%) had their consent being taken few hours before surgery and on the operating table. Majority received pre-anesthetic evaluation while at the operating table (56.3%). Information about surgery was delivered by surgeons who performed surgery in 39.4 % of the participants. On the other hand, 84.5% of the participants knew the diagnosis prior surgery,60.6% reported to have been informed about the benefits of the intended surgery while only 1.4% were informed about the alternative of the surgery. Only 26.9% were informed on the consequences of not undergoing surgery;38% were given time to ask questions, but only 40.8% were involved in making decisions for the intended surgery. Majority of the study participants (84.5%) knew the type of anesthesia to be used and only 8.5% were informed about possible risks for the intended surgery.

Conclusion: This study highlighted areas of weakness in surgical informed consent practice at Temeke regional referral hospital. Informed consent for surgery was mostly taken few hours before surgery and while on the operating table, pre-operative evaluation mostly was done while patients were on operating table, surgery risks and alternative to treatment options were poorly communicated. Therefore, every aspect of surgical informed consent should be well communicated to patients and given adequate time for decision making. Also for elective cases surgical informed consent should be taken a day before surgery to allow patients make their own decisions without anxiety.