A Study of Adequacy of informed consent for Caesarean Section at the University Teaching Hospital, Lusaka, Zambia

Abstract

Background. Informed consent consists of availing information to the patient in an understandable manner without coercion to allow the patient to make an informed decision about their health care. In the case of informed consent for caesarean section, this information must include the name, nature, intended benefits of the procedure, risks of the procedure, alternative procedures, implications on future reproductive health and anaesthetic options Little attention, in Zambia, has been paid to whether patients receive adequate consent before operation and its implications for future reproductive capacity; this study aims to explore this aspect.Methods. This was a cross sectional study in which post-caesarean section mothers were interviewed in the postnatal wards at the University Teaching Hospital (UTH), Lusaka, Zambia after under going emergency (n=l 15) and elective caesarean section (n=32). Information was obtained using a standardized questionnaire. Adequacy was determined by asking about elements of the consent process for caesarean section. Responses were scaled as: strongly agree, agree, don't know, disagree and strongly disagree - the first 2 categories were considered 'adequate' for each element. An overall 'adequacy' was determined based on responses to the name of procedure, nature of procedure and indications (as stated by the patient and verified from the case notes). Association of responses with type of informed consent was tested by calculating odds ratios. A p-value of 0.05 was taken as significant. The data was analysed using the SPSS software. Results. Of the 150 patients interviewed, overall 77 (51.3 %) were adequately consented. Factors significantly associated with adequacy of informed consent included: age, type of caesarean i.e. elective or emergency, outcome, whether consented by a doctor or nurse, asked questions, and told of the right to decline. Factors found not to have a significant association with adequacy of informed consent included: parity, marital status, educational level, residence, previous caesarean, agreed that caesarean was necessary, debriefing after caesarean and learnt of caesarean during the antenatal visits. In only 11 patients (7.3%) was the risk of caesarean section discussed and in 27 (18%) the implications for future pregnancies. Only 7 patients discussed anaesthetic options and 2 patients said they were allowed to choose their preference. Under half (about 40.7%) were unsure of what to expect in their next delivery but most (62.0%) would prefer to deliver normally. There was poor documentation of the consenting process in patients' notes - in only 14% were the process well documented. Conclusion. The wide variation in the extent of information provided for the different elements of the consent process for a caesarean section, the fact that overall only about half were considered adequately consented, poor documentation, uncertainty of how they will deliver in their next pregnancy, despite a preference to deliver normally rather than undergo another caesarean section, illustrates the need for a more detailed standardized consent form. This is to ensure consistency of information provided to patients. Further, this study draws attention for more training for health care workers involved in administering and documenting consent, and providing more awareness regarding caesarean section to patients in the antenatal period.