Assessment of the quality of informed consent process for elective gynaecological and obstetric surgical procedures in Kawempe National Referral Hospital

Abstract

Background: The WHO declaration on patients’ rights, the patient has to be fully informed about their health status and medical facts. Obtaining informed consent is to respect patient’s autonomy, therefore it’s more than just a patient’s signature on paper. Informed consent for elective gynaecological or obstetric surgeries is required to improve compliance. The study aimed to assess the quality of informed consent process among patients undergoing elective gynaecological and obstetric surgery at Kawempe National Referral Hospital. Methods: A cross sectional study was conducted among patients who had undergone elective gynaecological and obstetric surgery at Kawempe National Referral Hospital. A total of 130 patients were recruited by systematic random sampling. Quality of informed consent was determined using a 5-point Likert scale. The cut off score for poor quality was ≤ 3. Analyzed data with STATA 16. Used Chi-square to test the association between clinical and demographic characteristics and the quality of informed consent. Used logistic regression to analyze the factors associated with poor quality. P- value ˂0.05 was statistically significant. Results: The mean age of participants was 30.6 years with IQR of 25 -33 years. Most participants 103/130 (79.23%) had poor quality of informed consent. The factors associated with poor quality were: lower education level (aPR=4.71 95% CI: 2.76-15.98 p = ˂ 0.0001), not aware that consent was required (aPR=2.18 95% CI: 1.20-5.21, p = 0.012), not aware that consent was voluntary (aPR=2.01, 95% CI: 1.18-6.26, p=0.017), using English language (aPR=2.64, 95% CI: 1.12-6.73, p=0.022) an interpreter (aPR=3.11, 95% CI: 1.22-7.43, p=0.015), and words only (aPR=2.42, 95% CI: 1.27-9.69, p=0.019). Consenting on ward (aPR=1.96, 95% CI: 1.22-6.18, p=0.028), short time to discuss (aPR=2.76, 95% CI: 1.22-8.01, p=0.022). Not asking questions (aPR=2.11, 95% CI: 1.15-12.32, p=0.018) and not reading the consent form (aPR=2.32, 95% CI: 1.19-9.02, p=0.028). Most participants (86%) had a friendly and empathetic communication with their clinicians. Conclusions: Majority of patients get poor quality informed consent prior surgery especially those with low education. Recommendations: Health workers communicate the purpose of informed consent to patients. KNRH should follow the national guidelines for obtaining informed consent. A study to assess the knowledge of health workers on informed consent process in this setting is recommended.