Bakker Wouter, Zethof Siem, Nansongole Felix, Kilowe Kelvin, van Roosmalen Jos, van den Akker Thomas
St. Luke's Hospital, Malosa, Malawi.
Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
BMC Med Ethics. 2021 Mar 29;22(1):33. doi: 10.1186/s12910-021-00584-9.
Informed consent is a prerequisite for caesarean section, the commonest surgical procedure in low- and middle-income settings, but not always acquired to an appropriate extent. Exploring perceptions of health care workers may aid in improving clinical practice around informed consent. We aim to explore health workers' beliefs and experiences related to principles and practice of informed consent.
Qualitative study conducted between January and June 2018 in a rural 150-bed mission hospital in Southern Malawi. Clinical observations, semi-structured interviews and a focus group discussion were used to collect data. Participants were 22 clincal officers, nurse-midwives and midwifery students involved in maternity care. Data were analysed to identify themes and construct an analytical framework.
Definition and purpose of informed consent revolved around providing information, respecting women's autonomy and achieving legal protection. Due to fear of blame and litigation, health workers preferred written consent. Written consent requires active participation by the consenting individual and was perceived to transfer liability to that person. A woman's refusal to provide written informed consent may pose a dilemma for the health worker between doing good and respecting autonomy. To prevent such refusal, health workers said to only partially disclose surgical risks in order to minimize women's anxiety. Commonly perceived barriers to obtain a fully informed consent were labour pains, language barriers, women's lack of education and their dependency on others to make decisions.
Health workers are familiar with the principles around informed consent and aware of its advantages, but fear of blame and litigation, partial disclosure of risks and barriers to communication hamper the process of obtaining informed consent. Findings can be used to develop interventions to improve the informed consent process.
知情同意是剖宫产的前提条件，剖宫产是低收入和中等收入地区最常见的外科手术，但并非总能在适当程度上获得。探究医护人员的看法可能有助于改善围绕知情同意的临床实践。我们旨在探究卫生工作者与知情同意原则及实践相关的信念和经历。
2018年1月至6月在马拉维南部一家拥有150张床位的农村教会医院进行了定性研究。采用临床观察、半结构化访谈和焦点小组讨论来收集数据。参与者为22名参与产妇护理的临床干事、助产士和助产专业学生。对数据进行分析以确定主题并构建分析框架。
知情同意的定义和目的围绕提供信息、尊重妇女自主权以及实现法律保护。由于担心被指责和面临诉讼，医护人员更倾向于书面同意。书面同意要求同意者积极参与，并被视为将责任转移给该人。女性拒绝提供书面知情同意可能会使医护人员在行善与尊重自主权之间陷入两难境地。为防止此类拒绝，医护人员表示只部分披露手术风险以尽量减少女性的焦虑。普遍认为获得充分知情同意的障碍包括分娩疼痛、语言障碍、女性缺乏教育以及她们依赖他人做决定。
医护人员熟悉知情同意的原则并意识到其优势，但对被指责和诉讼的恐惧、风险的部分披露以及沟通障碍阻碍了获得知情同意的过程。研究结果可用于制定干预措施以改善知情同意过程。
