Attitude towards informed consent practice in a developing country: a community-based assessment of the role of educational status

BMC Medical Ethics

Wilfred Okwudili Okenwa⁴  Boniface Ikenna Eze¹  Emmanuel Ikechukwu Obi³  Kenneth Amaechi Agu² 

[1] Department of Ophthalmology, UNTH, Ituku/Ozalla, Enugu, Nigeria;Department of Surgery, University of Teaching Hospital (UNTH), Ituku/Ozalla, Enugu 400001, Nigeria;Department of Community Medicine, UNTH, Ituku/Ozalla, Enugu, Nigeria;Department of Surgery, Enugu State University Teaching Hospital Park Lane, Enugu, Nigeria

关键词: Attitude;    Educational status;    Informed consent;   

Others  :  1089998
DOI  :  10.1186/1472-6939-15-77

 received in 2014-04-01, accepted in 2014-09-10,  发布年份 2014

【 摘 要 】

Background

It has been reported by some studies that the desire to be involved in decisions concerning one’s healthcare especially with regard to obtaining informed consent is related to educational status. The purpose of this study, therefore, is to assess the influence of educational status on attitude towards informed consent practice in three south-eastern Nigerian communities.

Methods

Responses from consenting adult participants from three randomly selected communities in Enugu State, southeast Nigeria were obtained using self-/interviewer-administered questionnaire.

Results

There were 2545 respondents (1508 males and 1037 females) with an age range of 18 to 65 years. More than 70% were aged 40 years and below and 28.4% were married. More than 70% of the respondents irrespective of educational status will not leave all decisions about their healthcare to the doctor. A lower proportion of those with no formal education (18.5%) will leave this entire decision-making process in the hands of the doctor compared to those with tertiary education (21.9%). On being informed of all that could go wrong with a procedure, 61.5% of those with no formal education would consider the doctor unsafe and incompetent while 64.2% of those with tertiary education would feel confident about the doctor. More than 85% of those with tertiary education would prefer consent to be obtained by the doctor who will carry out the procedure as against 33.8% of those with no formal education. Approximately 70% of those who had tertiary education indicated that informed consent was necessary for procedures on children, while the greater number of those with primary (64.4%) and no formal education (76.4%) indicated that informed consent was not necessary for procedures on children. Inability to understand the information was the most frequent specific response among those without formal education on why they would leave all the decisions to the doctor.

Conclusion

The study showed that knowledge of the informed consent practice increased with level of educational attainment but most of the participants irrespective of educational status would want to be involved in decisions about their healthcare. This knowledge will be helpful to healthcare providers in obtaining informed consent.

【 授权许可】

   
2014 Agu et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Medical Association Declaration of Lisbonhttp://www.wma.net/en/30publications/10policies/14 webcite
• [2]Herbert V: Informed consent - a legal evaluation. Cancer 1980, 46:1042-1044.
• [3]The Belmont Report. http://ohsr.od.nih.gov/guidelines/belmont.html webcite
• [4]The Nuremberg Code. http://www.cirp.org/library/ethics/nuremberg/ webcite
• [5]Informed consent in human subject research. Office for the Protection of Research Subjectshttps://oprs.usc.edu/education/booklets webcite
• [6]Goodman RS: Legal liability and orthopaedic surgery - informed request. Orthopaedics 1984, 7:1764.
• [7]Medical and Dental Council of Nigeria: Codes of Medical Ethics in Nigeria. Surulere: Petruvanni Co. Ltd; 2004:26-31.
• [8]Jebbin NJ, Adotey JM: Informed consent: how informed are patients? Niger J Med 2004, 13:148-151.
• [9]Ezeome ER, Marshall PA: Informed consent practices in Nigeria. Dev World Bioeth 2009, 9(3):138-148.
• [10]Chu SH, Jeong SH, Kim EJ, Park MS, Park K, Nam M, Shim JY, Yoon YR: The views of patients and healthy volunteers on participation in clinical trials: an exploratory survey study. Contemp Clin Trials 2012, 33(4):611-619.
• [11]Agu KA: Informed consent policy and surgeons in Southeast Nigeria. Nig J Surg 2003, 9(2):39-41.
• [12]Irabor DO, Omonzejele P: Local attitudes, moral obligation, customary obedience and other cultural practices: their influence on the process of gaining informed consent for surgery in a tertiary institution in a developing country. Dev World Bioeth 2009, 1:34-42.
• [13]Edge RS, Krieger JL: Legal and Ethical Perspective in Healthcare. New York: Delmar Publishers; 1998:58-60.
• [14]Osime OC, Okojie O, Osadolor F, Mohammed S: Current practices and medico-legal aspects of pre-operative consent. East Afr Med J 2004, 81(7):331-335.
• [15]Keulers BJ, Scheltinga MRM, Houterman S, Van der Wilt GJ, Spauwen PHM: Surgeons underestimate their patients’ desire for preoperative information. World J Surg 2008, 32:964-970.
• [16]Waitzkin H: Doctor-patient communication: clinical implications of social scientific research. JAMA 1984, 252:2441-2446.
• [17]Sanwal AK, Kumar S, Sahni P, Nundy S: Informed consent in Indian patients. J R Soc Med 1996, 89(4):196-198.
• [18]Ogundiran TO, Adebamowo CA: Surgeon-patient information disclosure practices in southwestern Nigeria. Med Princ Pract 2012, 21:238-243.
• [19]Landsdown M, Martin L, Fallowfield L: Patient-physician interactions during early breast cancer treatment: results from an international online survey. Curr Med Res Opin 2008, 24:1891-1904.
• [20]Okonkwo CO: Medical negligence and the legal implications. In Medical Practice and the law in Nigeria. Edited by Umerah BC. Nigeria: Longman Nigeria Ltd; 1989:132.
• [21]National Population Commission (NPC) [Nigeria] and ORC Macro: Nigeria Demographic and Health Survey. Calverton, Maryland: National Population Commission and ORC Macro; 2008.
• [22]Miyata H, Tachimori H, Takahashi M, Saito T, Kai I: Disclosure of cancer diagnosis and prognosis: a survey of the general public’s attitude toward doctors and family holding discretionary powers. BMC Med Ethics 2004, 5:E7. BioMed Central Full Text
• [23]Gitanjali B, Raveendran R, Pandian DG, Sujindra S: Recruitment of subjects for clinical trials after informed consent: does gender and educational status make a difference? J Postgrad Med 2003, 49(2):109-113.
• [24]Davis TC, Holcombe RF, Berkel HJ, Pramanik S, Divers SG: Informed consent for clinical trials: a comparative study of standard versus simplified forms. J Natl Cancer Inst 1998, 90(9):669-674.
• [25]Dormandy E, Tsui EY, Marteau TM: Development of a measure of informed choice suitable for use in low literacy populations. Patient Educ Couns 2007, 66(3):278-295.
• [26]Zite NB, Wallace LS: Use of a low-literacy informed consent form to improve women’s understanding of tubal sterilization: a randomized controlled trial. Obstet Gynecol 2011, 117(5):1160-1166.
• [27]Wikipediahttps://www.nigeriabusinessfile.com/information/people/religion webcite