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患者对术前知情同意的认知与理解:来自坦桑尼亚的定性主题分析

Patients' perceptions and understanding of preoperative informed consent: A qualitative thematic analysis from Tanzania.

作者信息

Michael Steven, Kyejo Willbroad, Ismail Allyzain, Samji Sunil, Aghan Eric, Mbekenga Columba, Ali Athar

机构信息

Department of Surgery, Aga Khan University Medical College, Dar es Salaam, Tanzania.

Department of Family Medicine, Aga Khan University Medical College, Dar es Salaam, Tanzania.

出版信息

SAGE Open Med. 2025 Apr 28;13:20503121251331122. doi: 10.1177/20503121251331122. eCollection 2025.

Abstract

BACKGROUND

Informed consent, grounded in the ethical principle of autonomy, represents a patient's agreement to undergo a procedure. Given its critical role in protecting human rights and autonomy, obtaining informed consent before any surgery or procedure is now a mandatory practice. However, many studies question whether informed consent is conducted genuinely, ensuring proper understanding of the information disclosed, or merely serves as a medicolegal formality. This has led to increased malpractice, misunderstanding, anxiety, and overall postoperative dissatisfaction.

OBJECTIVE

This study aimed to explore patients' perceptions and experiences regarding the informed consent process for elective surgeries, identifying key challenges and areas for improvement.

METHODS

This descriptive qualitative study was conducted at Aga Khan Hospital using individual in-depth interviews. Fourteen patients who had undergone elective surgery were recruited. Baseline data were presented in tables, and inductive thematic analysis was used to interpret the qualitative data.

RESULTS

Seven themes emerged from the data: Consent as a legal formality, autonomy, and decision-making, insufficient information, time constraints and lack of opportunities for questions, use of medical jargon, patients' desired information, and overall satisfaction with care. Despite patients' higher levels of education and the hospital's patient-centered care approach, many felt the information provided was insufficient, superficial, and difficult to understand.

CONCLUSION

The study found a significant gap between the information patients desired and what was provided. Insufficient information, coupled with the use of medical jargon and time constraints, adversely affected the informed consent process. Enhancing clarity in communication and allowing adequate time for discussions could improve patient understanding and satisfaction.

摘要

背景

基于自主伦理原则的知情同意,代表着患者对接受一项医疗程序的认可。鉴于其在保护人权和自主权方面的关键作用,如今在任何手术或医疗程序前获取知情同意已成为一项强制性做法。然而,许多研究质疑知情同意是否是真正实施的,是否确保了对所披露信息的正确理解,还是仅仅作为一种法医学上的形式。这导致了医疗事故增加、误解、焦虑以及总体术后满意度下降。

目的

本研究旨在探索患者对择期手术知情同意过程的认知和体验,识别关键挑战和改进领域。

方法

本描述性定性研究在阿迦汗医院进行,采用个体深入访谈。招募了14名接受过择期手术的患者。基线数据以表格形式呈现,并采用归纳主题分析法对定性数据进行解读。

结果

数据中出现了七个主题:作为法律形式的同意、自主权和决策、信息不足、时间限制和缺乏提问机会、使用医学术语、患者期望的信息以及对护理的总体满意度。尽管患者受教育程度较高且医院采用以患者为中心的护理方法,但许多人认为所提供的信息不足、肤浅且难以理解。

结论

该研究发现患者期望的信息与所提供的信息之间存在显著差距。信息不足,再加上使用医学术语和时间限制,对知情同意过程产生了不利影响。提高沟通的清晰度并留出足够的讨论时间可以提高患者的理解度和满意度。

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本文引用的文献

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Informed consent: it is more than just a document.知情同意:它远不止是一份文件。
Plast Surg Nurs. 2010 Oct-Dec;30(4):259-61. doi: 10.1097/PSN.0b013e3181fd3885.
10
Patient assessments of the most important medical decision during a hospitalization.患者对住院期间最重要医疗决策的评估。
J Gen Intern Med. 2008 Oct;23(10):1659-65. doi: 10.1007/s11606-008-0736-4. Epub 2008 Jul 29.

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