Patients’ perceptions and understanding of pre-operative informed consent in tertiary care setting- Dar-es-salaam

Background: Informed consent under the ethical principle of autonomy demonstrates patient’s agreement to have procedure/intervention done to them. Considering its importance in safeguarding human rights and autonomy, it is now mandatory to take informed consent before any surgery/procedure. Many studies have questioned whether informed consent is being taken in tr ue spirit that ensures proper understanding of the disclosed information or it is just adhered to as a medico legal formality. Globally, studies have demonstrated that majority of patients do not fully understand even small matters regarding their health i ncluding diagnosis, treatment modalities and possible associated risks, because of limited knowledge, personal values and cultural beliefs. As a result, there have been an increase of mal practice, misunderstanding, anxiety and overall postoperative patie nt dissatisfaction. Objectives: The aim of the study was to explore patients perception s and understanding of pre operative informed consent at the Aga Khan Hospital Dar es salaam Methods: This was a hospital based descriptive qualitative study using individual in-depth interviews. Fourteen (14) patients who had undergone an elective surgery at the Aga Khan Hospital were recruited into the study. Baseline data was presented in tables while Inductive thematic analysis was used to analyze the qualitative data. Results: There were seven themes identified from the collected data; Consent as a legal and formality requirement, autonomy and decision making, insufficient information, time constraint and lack of questions and answer session, use of medical jargon, Information that patients want hear and overall satisfaction with care. Despite higher levels of education among patients and the culture of patient centered care in our hospital, it was surprising to find that most patients felt that the information provided to them was insufficient, superficial and was provided in a manner that was difficult for them to comprehend. Conclusion: Our study concluded that there is substantial chunk of information that our patients want to hear but that is not provided. Also insufficient information provision to patient and use of medical jargon while consenting compounded lack of comprehension. Time constraint and lack of questions and answer session were found to have negatively impact on the entire process of informed consent. Recommendation: To apply the basic steps of informed consent as per the JCIA guidelines, Patient literacy assessment and use of simplified communication and patient educational teaching tools. And finally where feasible the consent should be taken at the tie of theater listing as proposed in American Royal College of surgeons