Survey of informed consent for endoscopic retrograde cholangiopancreatography

Abstract

Prior to performance of gastrointestinal endoscopic procedures, physicians are generally required to appraise patients of potential risks, benefits, and alternatives. Components of the informed consent process require that: (1) consent be voluntary; (2) the patient be sufficiently mentally capable to engage in rational decision-making; and (3) "adequate information" be conveyed. Controversies reflected in both medical and legal literature concern the definition of "adequate information." To sample current opinion regarding consent for both diagnostic and therapeutic ERCP, members of the Indiana Gut Club and Midwest Gut Club were polled. From this group of academic and private practice physicians, 81 completed evaluations were compiled. Greater than 90% of physicians believed that pancreatitis and pancreatitis/bleeding/perforation must be mentioned for diagnostic and therapeutic ERCP, respectively. There was variation of opinion as to whether patients must be informed of potential need for surgery, prolonged hospital stay, or death. The performing physician was felt to be ultimately responsible for obtaining consent, although other health-care team members, excluding a secretary, could participate.

Consenting patients for endoscopic retrograde cholangiopancreatography: results of a survey of 182 UK endoscopists and 2059 of their patients

“…Although similar findings have been reported in Australia, Europe and North America [4][5][6][7], these variations warrant further examination, as they are likely to influence patients' ability to make informed decisions about the care they receive. This is underlined by the fact that inadequate consent and explanation is often cited as a contributory issue in cases of litigation arising after ERCP [14,15].…”

“…Development of quality assurance schemes for endoscopy, such as the Global Rating Scale in the UK [2], in addition to an increased focus on patient satisfaction [3], further emphasizes the importance of patients understanding the risks and benefits of any procedure recommended to them. Although a number of groups, including our own, have examined endoscopists' self-reported ERCP consent practice [4][5][6][7][8], few data are available regarding patients' experiences of ERCP, or their recall of information supplied to them as part of the procedure.…”

Survey of consent practices for inpatient colonoscopy and endoscopic retrograde cholangiopancreatography at a tertiary referral center

“…Once again this reflects practice elsewhere in the world. [2][3][4]15,16 We chose to focus on consent practices for inpatients undergoing colonoscopy and ERCP for several reasons. First, digestive endoscopy is the commonest invasive procedure performed by physicians and the use of colonoscopy is likely to increase as a screening and surveillance tool for colorectal neoplasia.…”

“…[2][3][4] Furthermore, many endoscopists do not provide adequate information to patients. [2][3][4][5] Open-access endoscopy (where a formal consultation is not undertaken by the endoscopist prior to performing the procedure) enables expeditious examination of the gastrointestinal system, and is widely practised, partly due to an unprecedented demand for endoscopy. However, the absence of prior consultation may compromise the process of obtaining consent in an appropriate and timely manner.…”

Evaluating Informed Consent for Colonoscopy

“…[7][8][9][10] Information about the process of colonoscopy, risks of the procedure, limitations, alternative options, sedation techniques, and recovery were identified as significant gaps in patient knowledge. Demographic correlations were difficult to identify due to the small sample size of the study.…”