The informed consent process for surgical procedures: perspectives of patients and next-of-kins in a lower middle-income country

Background: The informed consent process is a mandatory requirement for surgical procedures that enables patients to exercise autonomy and make informed decisions concerning their medical care, fully aware of the consequences. However, emerging evidence suggests inconsistent adherence to this requirement. Aim: This study investigated patients’ and next-of-kins perspectives and experiences of the informed consent process following the completion of a surgical procedure. Methods: Using a qualitative approach, patients and next-of-kins who had consented or offered proxy consent on behalf of a patient to undergo surgical procedures at a teaching hospital’s surgical departments in Ghana were purposively recruited. We audio-recorded and transcribed 30 semi-structured interviews with 15 patients and 15 next-of-kins. Two members of the team conducted an independent thematic analysis of the data, guided by Braun and Clarke’s six-step approach. Results: The data analysis generated four key themes related to the context, key elements, influencing factors, perceptions, and experiences of the informed consent process. The informed consent process took place in varied hospital settings, largely in the presence of next-of-kins and typically facilitated by a team of medical professionals, under private conditions where possible. Family opinion, doctors’ paternalism and trust in the doctor’s expertise seemed to be major factors that influenced the decision-making process. However, when conflicts emerged, the patient’s choice and best interest remained paramount in the final decision. The consent process often involved discussions regarding the medical condition, treatment options, and potential risks; participant experiences of these deliberations showed variability. Issues of time constraints, poor doctor-client communication, and language barriers often complicated the informed consent experience. Conclusion: Patient experiences of the informed consent process varied, which points to the importance of standardized guidelines and a more patient-centered approach. This approach should encourage continued collaboration and effective communication between medical professionals and patients/next-of-kins, while upholding the patient’s right to make an informed surgical decision.