C. D. Sutton1, J. D. Sharma2, G. C. Lynde1 1Emory University School Of Medicine,Anesthesiology,Atlanta, GA, USA 2Emory University School Of Medicine,Surgery,Atlanta, GA, USA
Introduction:
The continuum between paternalism and autonomy has garnered increasing attention in the recent past and is the subject of debate in current medical ethics literature. Much of the discussion is centered on informed consent and the evolving Western values of the last century. It is clear that the medical community believes that universal standards for bioethics including the tenant of informed consent should be upheld in the setting of humanitarian medical missions. However, differences in culture, language, and infrastructure complicate the issue of how to best approach the consent process for short-term surgical missions.
The obstacles to obtaining informed consent in the global health setting have been thoroughly discussed in the literature, but few if any studies have investigated these issues from the patient’s perspective. Our study sought to understand the patient’s experience of giving consent in the setting of a two-week surgical mission to Haiti. Using a survey, we addressed questions regarding interaction, communication, and our consent process in an effort to find a more culturally and ethically appropriate method of obtaining consent.
Methods: A survey was created and administered using the iPad app Quicktap Survey. The survey was written in English at a Flesch Kincaid Grade Level of 2.2 and was then translated into Haitian Creole. An interpreter was present for every survey to help patients read, understand, and answer the questions. All patients selected for surgery were offered the opportunity to participate after the consent process for their surgery was complete. Data was collected during both weeks of the two-week trip.
Results:
We surveyed 55 patients, of whom 80% were male and the average age was 40.9. 72% of patients had completed primary school or less, and 75% had never had surgery before.
Regarding communication, 93% reported that they felt comfortable asking questions of an American doctor, and 67% felt equally or more comfortable asking questions to an American doctor as compared to a Haitian doctor. However, only 47% reported finding communication using an interpreter to be easy, and 9% felt that their questions were not always understood when using an interpreter.
While 82% reported knowing the risks of their surgery, when asked to identify these risks 27% selected one or more sham answers. Regarding the idea of giving consent, 98% of patients felt it was important to understand their surgery and its risks, and 55 of 55 patients stated that signing a consent form that showed this understanding was important.
Conclusion: Our results highlight several areas needing improvement in the consent process including clearer risk communication and more effective use of interpreters. Our survey demonstrates that the process of obtaining informed consent for surgery is important to patients in the setting of short-term medical missions and suggests that continued efforts to improve our methods are critical.