L. A. Sceats1, R. Narayan1, A. Mezynski3, R. K. Woo2, A. M. Morris1, G. P. Yang1 1Stanford University,Surgery,Palo Alto, CA, USA 2University Of Hawaii,Pediatric Surgery,Honolulu, HI, USA 3Stanford University,S-SPIRE Center,Palo Alto, CA, USA
Introduction:
Interest in surgical missions to low- and middle-income countries (LMIC) is at an all-time high among surgeons in the United States. Ethical issues surround the care provided during these short-term trips, including whether informed consent is adequately conveyed. Little data exist about current practices, expectations, and limitations of informed consent on medical mission trips. In this pilot study, we examined physician communication of risk, translation adequacy, and patient comprehension among a population of adults undergoing inguinal hernia repair during a surgical mission trip in Guatemala.
Methods:
The study was conducted at a hospital in rural Guatemala that combines year round primary care with short-term surgical missions. All adult patients who were scheduled for inguinal herniorrhaphy in July 2017 agreed to participate. Within 10 minutes of a standard preoperative visit and consent conducted with a Spanish translator, patients underwent a separate structured interview covering sociodemographics and both closed- and open-ended questions to elicit comprehension. The informed consent process and post-visit interviews were audio-recorded, transcribed verbatim by a certified bilingual medical translator, independently coded by three researchers, and discussed to consensus. Using descriptive statistics and thematic analysis of open-ended responses, we integrated quantitative and qualitative methods focused on 1) clarity of information provided by surgeon, 2) accuracy of translation, and 3) patient understanding.
Results:
13 adult patients (mean age 49y, 76% male) were scheduled for inguinal herniorrhaphy; 61% had only a primary school education and 69% had no regular income. Surgeons uniformly conveyed standard risks of bleeding, infection, chronic pain and recurrence, but these were translated to patients only 49% of the time. All patients reported that they expected surgery would relieve pain and enable more activity. Within 10 minutes of the consent process, over 60% of patients indicated that they did not understand that postoperative recurrence or other complications were possible. Illustrative quotations are provided in Table 1.
Conclusion:
Despite visiting surgeons’ best attempts to provide adequate informed consent while on a foreign surgical mission, many patients did not comprehend the risks of surgery. Potential explanations include: low health literacy of patients, cultural disconnect with the concept of autonomy, surgeons’ delivery of information in large boluses of information, and failures of translation. Our pilot data reveal a critical need to develop more effective methods for communicating risk to patients about surgery completed as part of short-term medical missions to LMICs.
