A COMPARATIVE STUDY OF PATIENTS’ ATTITUDE TOWARDS INFORMED CONSENT IN PUBLIC AND PRIVATE HOSPITALS

Abstract

Background: Patient’s autonomy is an imperative issue in the health service field. It is a known fact that patient’s awareness and understanding of legal and ethical issues related to the consent process is often limited. Adequate information before a surgical procedure is fundamental to give informed consent. Information should include a description of the benefits, risks and complications of the intended procedure as well the alternative treatment options.

Objectives: The aim of this study was to compare patients in public and private hospitals of Kuwait as regards their understanding of legal implications, viewabout the scope, value and function of consent form during the clinical practice.

Methods: A comparative descriptive cross-sectional survey was conducted in 6 public and 2 private hospitals from January to June 2016 in the state of Kuwait. A total of 910 patients aged 18 years old and above admitted to the surgery departments in the selected hospitals were invited.  Structured self-administered questionnaires were distributed to the patients hospitalized in the selected departments of Kuwaiti hospitals. The questionnaire was pilot-tested prior to being finalized. Statistical analysis for the achieved data was done.

Results: Of 910 patients, 805 (88.5%) completed the questionnaires. Patients in public hospitals were 584 (72.5%) while those in private hospitals were 221 (27.5%).  Significantly higher proportion of patients in private hospitals were in the view that signing the consent form is a legal requirement (88.7%). Significantly more private sector patients agreed that signing the consent form means that all exactly are present in the consent form (91.0%), and the doctor cannot do anything different from what was on the form unless it is lifesaving (82.4%). More patients in private sector hospitals agreed about the statements that the consent form made it clear what was going to happen (79.6%) and the consent form gave the doctors control over what happened (72.9%). There were no statistical significant differences observed between patients in the two disciplines as regards their responses to the statements: the consent form is important (p = 0.167), the consent form made the patient aware of the risks of the operation (p = 0.520), the consent form made the patient wishes known (p = 0.393), the consent form prevents mix ups during the operation (p = 0.470), the consent form was just another piece of paper (p = 0.361), the patient just signed the consent form so he/she could have the operation (p = 0.053) and signing the consent form was mainly to protect the hospital (p = 0.049).

Conclusion: Patients in public and private hospitals have limited knowledge of the legal implications of signing or not signing consent forms, indicates that consenting in its current form is not informed and should be reassessed in order to achieve patient autonomy. The policy and decision makers need to develop educational program towards inform consent.

Keywords: Hospitals; Patients; Medical ethics; Informed Consent.