Residents' and patients' perspectives on informed consent in primary care clinics

Journal of Clinical Ethics

Volumn 11, Issue 1, 2000, Pages 39-48

  Kondo, Douglas G ^a   Bishop, F Marian ^b   Jacobson, Jay A ^b  

^a Karl Menninger School of Psychiatry   (United States)

^b UNIVERSITY OF UTAH SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; AMBULATORY CARE; ARTICLE; ATTITUDE TO HEALTH; EDUCATION; EMPIRICAL APPROACH; FEMALE; HEALTH PERSONNEL ATTITUDE; HUMAN; HYPERTENSION; INFORMED CONSENT; INTERPERSONAL COMMUNICATION; LDS HOSPITAL (SALT LAKE CITY, UT); MALE; MEDICAL EDUCATION; MEDICAL STAFF; METHODOLOGY; MIDDLE AGED; NEEDS ASSESSMENT; PATIENT EDUCATION; PRIMARY HEALTH CARE; PROFESSIONAL PATIENT RELATIONSHIP; PSYCHOLOGICAL ASPECT; QUESTIONNAIRE; RISK ASSESSMENT; UNITED STATES; UNIVERSITY OF UTAH;

EMPIRICAL APPROACH; LDS HOSPITAL (SALT LAKE CITY, UT); PROFESSIONAL PATIENT RELATIONSHIP; UNIVERSITY OF UTAH;

ADULT; AMBULATORY CARE; ATTITUDE OF HEALTH PERSONNEL; ATTITUDE TO HEALTH; DISCLOSURE; FEMALE; HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HUMANS; HYPERTENSION; INFORMED CONSENT; INTERNSHIP AND RESIDENCY; MALE; MEDICAL STAFF, HOSPITAL; MIDDLE AGED; NEEDS ASSESSMENT; PATIENT EDUCATION; PRIMARY HEALTH CARE; QUESTIONNAIRES; RISK ASSESSMENT; UTAH;

EID: 0034153409     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (39)

1. A. Meisel and M. Kuczewski, "Legal and Ethical Myths about Informed Consent," Archives of Internal Medicine 156, no. 22 (1996): 2521-6.
2. R.R. Faden and T.L. Beauchamp, A History and Theory of Informed Consent (New York: Oxford University Press, 1986), 7-14.
3. P.S. Appelbaum, C.W. Lidz, and A. Meisel, Informed Consent: Legal Theory and Clinical Practice (New York: Oxford University Press, 1987), 49-62.
4. L.M. Lesko et al., "Patients,' Parents' and Oncologists' Perceptions of Informed Consent for Bone Marrow Transplantation," Medical and Pediatric Oncology 17, no. 3 (1989): 181-7.
5. N. Bittar, "Maintaining Long-Term Control of Blood Pressure: The Role of Improved Compliance," Clinical Cardiology 18, no. 6 (suppl. III) (1995): 12-6.
6. J.F. Schultz and S.G. Sheps, "Management of Patients with Hypertension: A Hypertensive Clinic Model," Mayo Clinic Proceedings 69, no. 10 (1994): 997-9.
7. W.J. Elliott, "Compliance Strategies," Current Opinion in Nephrology and Hypertension 3, no. 3 (1994): 271-8; K.C. Farmer, E.W. Jacobs, and C.R. Phillips, "Long-Term Patient Compliance with Prescribed Regimens of Calcium Channel Blockers," Clinical Therapeutics 16, no. 2 (1994): 316-26; A.F. Schaub, A. Steiner, and W. Vetter, "Compliance to Treatment," Clinical and Experimental Hypertension 15, no. 6 (1993): 1121-30; see note 6 above.
8. W.J. Elliott, "Compliance Strategies," Current Opinion in Nephrology and Hypertension 3, no. 3 (1994): 271-8; K.C. Farmer, E.W. Jacobs, and C.R. Phillips, "Long-Term Patient Compliance with Prescribed Regimens of Calcium Channel Blockers," Clinical Therapeutics 16, no. 2 (1994): 316-26; A.F. Schaub, A. Steiner, and W. Vetter, "Compliance to Treatment," Clinical and Experimental Hypertension 15, no. 6 (1993): 1121-30; see note 6 above.
9. W.J. Elliott, "Compliance Strategies," Current Opinion in Nephrology and Hypertension 3, no. 3 (1994): 271-8; K.C. Farmer, E.W. Jacobs, and C.R. Phillips, "Long-Term Patient Compliance with Prescribed Regimens of Calcium Channel Blockers," Clinical Therapeutics 16, no. 2 (1994): 316-26; A.F. Schaub, A. Steiner, and W. Vetter, "Compliance to Treatment," Clinical and Experimental Hypertension 15, no. 6 (1993): 1121-30; see note 6 above.
10. H.S. Perkins, "Teaching Medical Ethics During Residency," Academic Medicine 64, no. 5 (1989): 262-9.
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13. E.J. Williams, The Physician's Legal Guide: A Handbook of Utah Laws Affecting the Practice of Medicine (Salt Lake City, Ut.: Utah Medical Association, 1990), 81-2.
14. Statistical analysis was performed using the application SPSS for Windows, version 6.1. The chi-square test was used to look for differences between program, year, and recalling a course covering infomed consent in the self-reporting of practices portion of the resident survey. The chi-square test was also used to look for differences in observed clinical behaviors between residents in different training programs and postgraduate years, but not based on whether the resident recalled a course covering informed consent. Because the survey was anonymous, direct comparison between self-reported practices and actual behaviors on an individual basis was not possible. However, aggregate data were calculated and are presented in table 3.
15. The multivariate linear regression model used to interpret the knowledge-assessment portion of the survey featured quiz score as the dependent variable, with training program, year of postgraduate training, and recall of a course covering informed consent as the independent variables.
16. The chi-square test for association was applied separately to each informed-consent practice (as self-reported by residents in the written survey, n = 99), together with the variables of residency program (University Internal Medicine, University Family Practice, LDS Hospital Internal Medicine), year of training (1, 2, and 3), and recall of a course in medical school that covered informed consent (yes, no). Of the 17 informed-consent behaviors surveyed, only the four mentioned in the text demonstrated statistically significant associations.
17. The chi-square test for association was applied separately to each informed-consent practice (as observed in the clinic by the participant-observer, n = 52), together with the variables of residency program (University Internal Medicine, University Family Practice, LDS Hospital Internal Medicine) and postgraduate year (1, 2, and 3). No significant associations between observed informed-consent practices and training program (p = .07 to 0.67) or post-graduate year (p = .08 to 0.83) were revealed. During the clinic observations, it was not ascertained whether the resident recalled a medical school course that covered informed consent.
18. The statements and patients' responses (disagree strongly, disagree somewhat, no opinion, agree somewhat, agree strongly) are as follows: I make my own "decisions regarding my medical treatment" (4 percent, 12 percent, 4 percent, 63 percent, 17 percent); "I understand high blood pressure well enough to make treatment decisions" (2 percent, 46 percent, 29 percent, 19 percent, 4 percent); "I felt pressure to accept the doctor's recommendation" (8 percent, 38 percent, 48 percent, 6 percent, 0 percent); "It's too complicated to try to understand everything the doctor said" (0 percent, 25 percent, 8 percent, 59 percent, 8 percent); "Thorough medical explanations are only for serious things, like surgery" (12 percent, 35 percent, 35 percent, 16 percent, 2 percent); "Doctors only need to ask permission for serious things, like surgery" (21 percent, 25 percent, 31 percent, 23 percent, 0 percent); "I find it hard to keep track of when to take my medicine" (12 percent, 30 percent, 15 percent, 37 percent, 6 percent); "I know other ways to lower my blood pressure besides taking medicine" (0 percent, 29 percent, 48 percent, 17 percent, 6 percent); "I have the right to refuse medical treatments, including drugs" (0 percent, 0 percent, 32 percent, 34 percent, 34 percent); "I have unanswered questions about high blood pressure" (4 percent, 48 percent, 29 percent, 17 percent, 2 percent); "I have unanswered questions about my blood pressure medicine" (6 percent, 34 percent, 31 percent, 29 percent, 0 percent); "It's important to me that the doctor discuss the cost of a prescription" (2 percent, 21 percent, 32 percent, 35 percent, 10 percent).
19. D.P. Sulmasy et al., "Medical House Officers' Knowledge, Attitudes and Confidence Regarding Medical Ethics," Archives of Internal Medicine 150, no. 12 (1990): 2509-13.
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21. M.J. Gordon, "A Review of the Validity and Accuracy of Self-Assessments in Health Professions Training," Academic Medicine 66, no. 12 (1991): 762-9.
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23. W.G. Wu and R.A. Pearlman, "Consent in Medical Decision Making: The Role of Communication," Journal of General Internal Medicine 3, no. 1 (1988): 9-14; D.P. Sulmasy et al., "Patients' Perceptions of the Quality of Informed Consent for Common Medical Procedures," The Journal of Clinical Ethics 5, no. 3 (Fall 1995): 189-94.
24. C.H. Braddock et al., "How Doctors and Patients Discuss Routine Clinical Decisions: Informed Decision Making in the Outpatient Setting," Journal of General Internal Medicine 12, no. 6 (1997): 339-45.
25. D.L. Duffy, D. Hamerman, and M.A. Cohen, "Communication Skills of House Officers: A Study in a Medical Clinic," Annals of Internal Medicine 93, no. 2 (1980): 354-7.
26. Sulmasy et al., see note 20 above.
27. C.W. Lidz, P.S. Appelbaum, and A. Meisel, "Two Models of Implementing Informed Consent," Archives of Internal Medicine 148, no. 6 (1988): 1385-9.
28. M. Pirmohamed et al., "Adverse Drug Reactions," British Medical Journal 316, no. 7140 (1998): 1295-8.
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30. C.K. O'Neil and T.I. Poirer, "Impact of Patient Knowledge, Patient-Pharmacist Relationship, and Drug Perceptions on Adverse Drug Therapy Outcomes," Pharmacotherapy 18, no. 2 (1998): 333-40.
31. See note 20 above.
32. J. He and P.K. Whelton, "Epidemiology and Prevention of Hypertension," Medical Clinics of North America 81, no. 5 (1997): 1077-97.
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34. S.A. Eraker, J.P. Kirscht, and M.H. Becker, "Understanding and Improving Patient Compliance," Annals of Internal Medicine 100, no. 2 (1984): 258-68.
35. P. Ley, "Doctor-Patient Communication: Some Quantitative Estimates of the Role of Cognitive Factors in Non-Compliance," Journal of Hypertension 3, suppl. 1 (1985): 51-5; J.L. Richardson, "Perspectives on Compliance with Drug Regimens among the Elderly," Journal of Comprehensive Health Care 1, no. 4 (1986): 33-46.
36. P. Ley, "Doctor-Patient Communication: Some Quantitative Estimates of the Role of Cognitive Factors in Non-Compliance," Journal of Hypertension 3, suppl. 1 (1985): 51-5; J.L. Richardson, "Perspectives on Compliance with Drug Regimens among the Elderly," Journal of Comprehensive Health Care 1, no. 4 (1986): 33-46.
37. R.W. Sanson-Fisher and K. Clover, "Compliance in the Treatment of Hypertension: A Need for Action," American Journal of Hypertension 8, no. 10 (1995): 82s-88s.
38. See note 8 above.
39. See note 9 above.