Assessment of Effectiveness of Pre-Operative Consenting in Major Gynecological Surgeries

One of the key elements of gynecological surgeries is proper consenting for procedures. The patient has the right to know details of interventions about to undergo for her condition. Effectiveness of obtaining valid consent influence patient care and deficits of consent process creates gaps in management. When unanticipated or anticipated complications encounter during surgery, in the presence of valid consenting clinicians can make decisions to alter desired procedure and this minimize legal issues as patient is already explained and accepted the risks and complications. Despite of many patient care guidelines, safety precautions or check lists still marked reductions of valid consenting process is observed in many clinical settings. This audit conducted to evaluate strengths and deficiencies of consenting process conducted in Professorial Unit, Kalubowila. 56 patients awaiting major gynecological procedures were questioned with self-administered questionnaire following initial consenting process for preplanned surgical intervention by intern medical officers. Each patient’s understanding for surgery re-evaluated and we used pictorial consent formats as a tool. Questionnaire prepared in Sinhala, English and Tamil formats to overcome language issues.
Post-evaluation analysis revealed surprising results as 3.47% of the selected population was not aware of the surgical procedure they are to undergo, and the same percentage of population was not aware of the indication for their respective surgeries. 21.42% of the population was not aware of the mode of anesthesia used for their surgery whereas site and type of incision was not known to 17.85% of the study population. The route of surgery (Laparoscopy/Laparotomy/vaginal) of their respective surgeries was not known by 50% of the select-ed population and the possibility of conversion of laparoscopic surgery into an open laparotomy was not known to 39.28% of the study population. 28.57% was not aware of the possible complications of the surgery. Only 50% of the patients had prior knowledge regarding the surgical procedure they undergo while the rest was educated only during the consent taking procedure. 21.42% declared that the time duration was not adequate for them to consent with proper knowledge regarding the procedure. 17.85% had not gotten adequate opportunity to clarify their doubts and postoperative management plan was not known by 53.54% of the study population. Furthermore 10.72% was not satisfied with the health education and the clarifications done by the medical team for their queries regarding the surgical procedure.