Percutaneous coronary intervention patients' and cardiologists' experiences of the informed consent process in Northern England : a qualitative study

Probyn, JE; Greenhalgh, J; Holt, J; Conway, D; Astin, F

Abstract

Objective
Informed consent is central to ethical medical
practice, but little is known about how the process
takes place in clinical practice. Percutaneous coronary
intervention (PCI) is a common revascularisation
procedure. Studies report that patients overestimate
benefits, forget the risks and are unaware of alternative
treatments. The aim of this study was to describe PCI
patients’ and cardiologists’ experiences of the informed
consent process in acute care settings.

Design/setting/participants
A qualitative study with a maximum variation sample of elective and acute PCI patients and cardiologists taking their consent, recruited from a district general hospital and tertiary centre. Indepth interviews were conducted, and consent discussions were audio recorded. Data collection, coding and
theorising occurred simultaneously.

Findings
Forty-one (26 male) patients scheduled for
elective (20) or urgent (21) PCI and 19 cardiologists
(5 female) participated. Despite diversity in patients’
experiences of informed consent, elective and acute
patients experienced a common four-stage process
of consent. Most patients made the decision to have
treatment at PCI referral and took a passive role in the
discussions we recorded. They recognised cardiologists
as experts, trusted the medical system to ‘fix’ their health
problem and were unaware of their role in the informed
consent process. Informed consent discussions functioned
as a formal ‘event’,enabling cardiologists to check
patients’ understanding and enabling patients to access
treatment.

Conclusions
The configuration of services and patients’
perceptions of their role in informed consent underpin a
mismatch between legal and ethical principles of informed
consent and current practice. The variation in patients’
experiences of the current place of informed consent
in service delivery represents a missed opportunity for
cardiologists to work in decision-making partnerships
with patients. In light of recent changes in the law, a new
approach to informed consent is required.

Citation

Probyn, J., Greenhalgh, J., Holt, J., Conway, D., & Astin, F. (2017). Percutaneous coronary intervention patients' and cardiologists' experiences of the informed consent process in Northern England : a qualitative study. BMJ Open, 7(6), https://doi.org/10.1136/bmjopen-2016-015127

• Journal Article Type: Article
• Acceptance Date: Mar 24, 2017
• Online Publication Date: Jun 24, 2017
• Publication Date: Jun 24, 2017
• Deposit Date: Jul 4, 2017
• Publicly Available Date: Jul 4, 2017
• Journal: BMJ Open
• Publisher: BMJ Publishing Group
• Volume: 7
• Issue: 6
• DOI: https://doi.org/10.1136/bmjopen-2016-015127
• Publisher URL: http://dx.doi.org/10.1136/bmjopen-2016-015127
• Related Public URLs: http://bmjopen.bmj.com/
• Additional Information: Projects : Patients' and cardiologists' experiences of informed consent for PCI