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ASSESSMENT OF INFORMED CONSENT IN SELECTED HEALTH FACILITIES IN BENIN CITY, EDO STATE
Abstract
Introduction: Informed consent is considered the most important step in health-related research and clinical interventions and its central justification is the respect of patient autonomy. This study aimed at assessing informed consent practices in health facilities in Benin City, Edo State.
Methods: A descriptive cross-sectional study design was used in this study and data was collected using both quantitative and qualitative methods. Pre-tested, structured questionnaires were administered to 403 patients and 401 clinicians recruited from private and public health facilities in Benin City. An evaluation checklist was used to assess the content of informed consent documents used in health facilities recruited for the study. In addition, 32 focus group discussion participants and 2 key informants were interviewed for the purpose of the study. Data analysis was carried out using IBM SPSS version 20.0 and the level of significance was set at p < 0.05.
Results: Less than a third (32.4%) of respondents had good knowledge of the informed consent process. A positive attitude toward the informed consent process was seen almost universally (93.1%) by patients but a lower proportion (73.9%) opined that the consent process was of good quality. Age (p = 0.0042; CI: 1.002-1.089) and level of education (p = 0.013; CI: 1.233-5.837) were significant predictors of patients’ attitude toward the informed consent process. Over four fifths of consent forms either did not contain or make provision for the elements considered necessary for valid consent documentation. Over a third of clinicians (35.2%), had good knowledge of the informed consent process but a higher proportion of clinicians (50.4%) had good informed consent practices. Age of clinician was a significant predictor of both knowledge of the informed consent process (p = 0.015; CI: 0.845-0.997) and practice of informed consent (p = 0.003; CI: 1.042-1.230).
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Conclusion: Despite the lack of patients’ knowledge of the informed consent process, most patients had a positive attitude toward the informed consent process. A significant proportion of patients determined that good quality consent was taken in the health facilities where they accessed care. Most informed consent documents examined in this study lacked the basic elements of informed consent. Over half of the clinicians had good informed consent practices despite their poor knowledge of the informed consent process. There is a strong need for health facilities to develop written materials and audio-visual resources to foster patients’ understanding of the informed consent process. Priority should be given to clinicians’ training in bioethics so as to improve their knowledge of the informed consent process and add value to their clinical practice.
