Surgical consent practice in the UK following the Montgomery ruling: A national cross-sectional questionnaire study

McKinnon, Chris; Loughran, Dafydd; Finn, Roísín; Coxwell-Matthewman, Madeline; Jeyaretna, Sanjeeva; Williams, Adam

doi:10.1016/j.ijsu.2018.05.016

Cited by 13 publications

(17 citation statements)

References 25 publications

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“…We recommend a reconfiguration and standardisation of the PCI patient pathway that allows the doctor, patient, and those close to them, the necessary time to develop a therapeutic relationship. An absence of protected time has been identified as an obstacle to a quality consent process for surgeons, 35 and we believe that this also applies in the field of interventional cardiology.…”

Section: Discussionmentioning

confidence: 91%

Cardiologists’ and patients’ views about the informed consent process and their understanding of the anticipated treatment benefits of coronary angioplasty: A survey study

Astin

Stephenson

Probyn

et al. 2019

European Journal of Cardiovascular Nursing

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Background: Percutaneous Coronary Intervention (PCI) is a common revascularisation technique. Serious complications are uncommon, but death is one of them. Seeking informed consent in advance of PCI is mandatory. Research shows that PCI patients have inaccurate perceptions of risks, benefits, and alternative treatments. Aim: To assess cardiologists' and patients' views about the informed consent process and anticipated treatment benefits. Methods: Two cross-sectional, anonymous surveys were distributed in England. An electronic version to a sample of cardiologists, and a paper based version to patients recruited from 10 centres. Results: A sample of 118 cardiologists and 326 patients completed the surveys. Cardiologists and patients shared similar views on the purpose of informed consent; however, over 40% of patients and over a third of cardiologists agreed with statements that patients do not understand, or remember, the information given to them. Patients placed less value than cardiologists upon the consent process and over 60% agreed that patients depended on their doctor to make the decision for them.Patients' and cardiologists views on the benefits of PCI were significantly different; notably, 60% of patients mistakenly believed PCI was curative. Conclusions: The PCI informed consent process requires improvement to ensure that patients are more involved and accurately understand treatment benefits to make an informed decision.Redesign of the patient pathway is recommended to allow protected time for health professionals to engage in discussions using evidence based approaches such as 'teach back' and decision support which improve patient comprehension.

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Section: Discussionmentioning

confidence: 91%

Cardiologists’ and patients’ views about the informed consent process and their understanding of the anticipated treatment benefits of coronary angioplasty: A survey study

Astin

Stephenson

Probyn

et al. 2019

European Journal of Cardiovascular Nursing

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“…Another possibility, discussed in many papers, is that the disclosure requirements in Montgomery will create taxing burdens for doctors 7,21,29,43,53,54,59,63‐68,94,98,102 . For example, Choudry et al comment that it creates ‘extra demands on clinical appointments that will be difficult to meet at a time of constrained resources’, 59 and there is some empirical evidence that doctors share this concern 10,44,66 .…”

Section: Resultsmentioning

confidence: 99%

“…A common claim in the literature—particularly in the medical literature‐‐is that Montgomery 's impact on medical practice might be limited by doctors' limited awareness of the ruling 10,11,49,53,55,56,66,67,69,102,103 …”

Section: Resultsmentioning

confidence: 99%

“…For these reasons, many conclude that we need to improve doctors' understanding of UK consent law 44,52,55,67,88 . Wheeler et al argue that ‘this disparity between what is and what should be known dates from a long‐term failure of medical education to teach clinical law’ 88 .…”

Section: Resultsmentioning

confidence: 99%

“…Many articles focus on the Court's elevation of patient autonomy and its disapproval of medical paternalism 3,5‐10,12‐17,19,22,25‐28,30‐68,70‐86,90 . The case is described as ‘the final step in a legal power shift from paternalism to patient autonomy’ 40 and ‘a landmark case…which shifted focus from a traditional paternalistic model of consent towards a more patient‐centred approach’ 33 .…”

Section: Resultsmentioning

confidence: 99%

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Montgomery's legal and practical impact: A systematic review at 6 years

Gallez

Skopek

Liddell

et al. 2021

Evaluation Clinical Practice

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Rationale, Aims and Objectives Six years ago, the Supreme Court judgement in Montgomery v Lanarkshire changed medical law. It introduced a new patient‐based standard of care for the communication of treatment risks and alternatives, rejecting the doctor‐based standard that had long governed all aspects of medical negligence. This is the first systematic review to analyse the literature on Montgomery. Our aim is to appraise and synthesize the literature on Montgomery's impact on medicine and the law and to identify areas for further academic enquiry and implications for professional guidance and training. Methods Searches were run in Medline, Embase, PsycINFO, Web of Science, Scopus, Westlaw UK, HeinOnline, and LexisNexis. Two reviewers screened papers. Extracted data was analysed and discussed by an interdisciplinary team. PRISMA guidelines were followed. Results Of the 1134 papers identified, 100 met the inclusion criteria. These papers revealed significant disagreement on four core sets of issues, focusing on Montgomery's impact on: (1) legal and professional duties; (2) medical practice; (3) the patient experience; and (4) litigation. The first set addresses whether the case actually changed doctors' legal and professional duties, the relationship between GMC guidance and medical law, and the boundaries of Montgomery. The second explores whether the decision has incentivized defensive medicine, its resource implications, and doctors' knowledge of it. The third concerns whether and how the decision has promoted patient autonomy and involvement in their own care. The fourth focuses on whether the case has caused an increase in litigation. Conclusions Despite the abundance of legal and medical literature on Montgomery, many issues remain unresolved. Empirical research is required for many of the questions. Doctrinal analysis informed by medical knowledge is also required to assess whether Montgomery may have unrecognized ramifications—for example, whether it will require the disclosure of risks associated with diagnostic uncertainty, where doctors advise patients without performing procedures.

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Does content of informed consent forms make surgeons vulnerable to lawsuits?

Ekmekçi

Güner

Toman

et al. 2020

Asian Journal of Surgery

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Surgical consent practice in the UK following the Montgomery ruling: A national cross-sectional questionnaire study

Abstract: On the basis of these findings, we identify a need to develop strategies to improve the consent process across the NHS and limit the predicted rise in litigation claims.

Cited by 13 publications

References 25 publications

Cardiologists’ and patients’ views about the informed consent process and their understanding of the anticipated treatment benefits of coronary angioplasty: A survey study

Cardiologists’ and patients’ views about the informed consent process and their understanding of the anticipated treatment benefits of coronary angioplasty: A survey study

Montgomery's legal and practical impact: A systematic review at 6 years

Does content of informed consent forms make surgeons vulnerable to lawsuits?

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