Patient consent in the post-Montgomery era

A national multi-speciality prospective study

Stephen R. Knight* (Corresponding Author), Robert Pearson, Ciara Kiely, Grace Lee, Alisdair J. MacDonald, Angus Macdonald, the Scottish Surgical Research Collaborative (SSRG), M Joy

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: The Montgomery ruling has had a wide-ranging impact on the consent process and has been the subject of new guidelines by bodies, including the Royal College of Surgeons (RCSEng). This is the first study to examine the current standard of consent for surgical procedures at a national level. Method: A national collaborative research model was used, with prospective data collection performed across hospitals in Scotland. Variables associated with the consent process were audited across three surgical specialities (general surgery, urology and orthopaedics) and measured against standards set by RCSEng, the Scottish Public Services Ombudsman and medical defence organisations. Results: A total of 289 cases were identified from 12 hospitals. The majority of patients were reviewed by a consultant surgeon in clinic (79.9%) or on the day of surgery (55.4%). The clinic consent rate was 27.0%, while a copy of the documented discussion was only provided to 4.2% of patients. On the day of surgery, the benefits, risks and alternatives to the planned procedure were discussed in less than half of cases. This rate was similar across different clinician grades, while marked variation was seen across hospitals. Conclusion: In this prospective multi-centre study we have demonstrated wide variation in the consent processes in many surgical specialities across Scotland. Following the Montgomery ruling, we have demonstrated the current consent process in elective surgery is likely to be substandard, and may require additional steps to be taken by clinicians to ensure patients are fully informed to make decisions regarding their treatment.

Original languageEnglish
Pages (from-to)277-283
Number of pages7
JournalSurgeon
Volume17
Issue number5
Early online date10 Oct 2018
DOIs
Publication statusE-pub ahead of print - 10 Oct 2018

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Scotland
Prospective Studies
Ambulatory Surgical Procedures
Urology
Consultants
Orthopedics
Guidelines
Research
Surgeons
Therapeutics

Keywords

  • Consent
  • Medico-legal
  • Montgomery
  • Surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Knight, S. R., Pearson, R., Kiely, C., Lee, G., MacDonald, A. J., Macdonald, A., ... Joy, M. (2019). Patient consent in the post-Montgomery era: A national multi-speciality prospective study. Surgeon, 17(5), 277-283. https://doi.org/10.1016/j.surge.2018.08.009

Patient consent in the post-Montgomery era : A national multi-speciality prospective study. / Knight, Stephen R. (Corresponding Author); Pearson, Robert; Kiely, Ciara; Lee, Grace; MacDonald, Alisdair J.; Macdonald, Angus; the Scottish Surgical Research Collaborative (SSRG); Joy, M.

In: Surgeon, Vol. 17, No. 5, 10.2019, p. 277-283.

Research output: Contribution to journalArticle

Knight, SR, Pearson, R, Kiely, C, Lee, G, MacDonald, AJ, Macdonald, A, the Scottish Surgical Research Collaborative (SSRG) & Joy, M 2019, 'Patient consent in the post-Montgomery era: A national multi-speciality prospective study', Surgeon, vol. 17, no. 5, pp. 277-283. https://doi.org/10.1016/j.surge.2018.08.009
Knight SR, Pearson R, Kiely C, Lee G, MacDonald AJ, Macdonald A et al. Patient consent in the post-Montgomery era: A national multi-speciality prospective study. Surgeon. 2019 Oct;17(5):277-283. https://doi.org/10.1016/j.surge.2018.08.009
Knight, Stephen R. ; Pearson, Robert ; Kiely, Ciara ; Lee, Grace ; MacDonald, Alisdair J. ; Macdonald, Angus ; the Scottish Surgical Research Collaborative (SSRG) ; Joy, M. / Patient consent in the post-Montgomery era : A national multi-speciality prospective study. In: Surgeon. 2019 ; Vol. 17, No. 5. pp. 277-283.
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abstract = "Background: The Montgomery ruling has had a wide-ranging impact on the consent process and has been the subject of new guidelines by bodies, including the Royal College of Surgeons (RCSEng). This is the first study to examine the current standard of consent for surgical procedures at a national level. Method: A national collaborative research model was used, with prospective data collection performed across hospitals in Scotland. Variables associated with the consent process were audited across three surgical specialities (general surgery, urology and orthopaedics) and measured against standards set by RCSEng, the Scottish Public Services Ombudsman and medical defence organisations. Results: A total of 289 cases were identified from 12 hospitals. The majority of patients were reviewed by a consultant surgeon in clinic (79.9{\%}) or on the day of surgery (55.4{\%}). The clinic consent rate was 27.0{\%}, while a copy of the documented discussion was only provided to 4.2{\%} of patients. On the day of surgery, the benefits, risks and alternatives to the planned procedure were discussed in less than half of cases. This rate was similar across different clinician grades, while marked variation was seen across hospitals. Conclusion: In this prospective multi-centre study we have demonstrated wide variation in the consent processes in many surgical specialities across Scotland. Following the Montgomery ruling, we have demonstrated the current consent process in elective surgery is likely to be substandard, and may require additional steps to be taken by clinicians to ensure patients are fully informed to make decisions regarding their treatment.",
keywords = "Consent, Medico-legal, Montgomery, Surgery",
author = "Knight, {Stephen R.} and Robert Pearson and Ciara Kiely and Grace Lee and MacDonald, {Alisdair J.} and Angus Macdonald and {the Scottish Surgical Research Collaborative (SSRG)} and F. Ravi and G. Ramsay and H. Sellars and C. Macleod and Robertson, {J. H.} and Oliver, {W. M.} and Ventham, {N. T.} and A. Turnbull and E. Dunstan and R. Webber and A. Norton and R. Shearer and Clement, {K. D.} and J. Kilkenny and Lim, {J. W.} and Wilson, {M. S.J.} and J. Littlechild and M Joy and C. Donoghue and D. Mansouri and Dreyer, {B. A.} and R. Stevenson and L. Clark and K. Yong and N. Fostyk and R. Tummon and R. Jack and M. Boland and D. Speake and F. Savioli and D. Hughes",
note = "Acknowledgements The authors would like to thank Dr Roger Palmer (Senior Medicolegal advisor, Medical Protection Society) and Dr Christine Bradford (Medico-legal adviser, Medical Defence Union and course tutor in Medical ethics, University of Edinburgh) for their specialist advice and support in developing the study protocol.",
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AU - Lee, Grace

AU - MacDonald, Alisdair J.

AU - Macdonald, Angus

AU - the Scottish Surgical Research Collaborative (SSRG)

AU - Ravi, F.

AU - Ramsay, G.

AU - Sellars, H.

AU - Macleod, C.

AU - Robertson, J. H.

AU - Oliver, W. M.

AU - Ventham, N. T.

AU - Turnbull, A.

AU - Dunstan, E.

AU - Webber, R.

AU - Norton, A.

AU - Shearer, R.

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AU - Kilkenny, J.

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AU - Wilson, M. S.J.

AU - Littlechild, J.

AU - Joy, M

AU - Donoghue, C.

AU - Mansouri, D.

AU - Dreyer, B. A.

AU - Stevenson, R.

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AU - Tummon, R.

AU - Jack, R.

AU - Boland, M.

AU - Speake, D.

AU - Savioli, F.

AU - Hughes, D.

N1 - Acknowledgements The authors would like to thank Dr Roger Palmer (Senior Medicolegal advisor, Medical Protection Society) and Dr Christine Bradford (Medico-legal adviser, Medical Defence Union and course tutor in Medical ethics, University of Edinburgh) for their specialist advice and support in developing the study protocol.

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N2 - Background: The Montgomery ruling has had a wide-ranging impact on the consent process and has been the subject of new guidelines by bodies, including the Royal College of Surgeons (RCSEng). This is the first study to examine the current standard of consent for surgical procedures at a national level. Method: A national collaborative research model was used, with prospective data collection performed across hospitals in Scotland. Variables associated with the consent process were audited across three surgical specialities (general surgery, urology and orthopaedics) and measured against standards set by RCSEng, the Scottish Public Services Ombudsman and medical defence organisations. Results: A total of 289 cases were identified from 12 hospitals. The majority of patients were reviewed by a consultant surgeon in clinic (79.9%) or on the day of surgery (55.4%). The clinic consent rate was 27.0%, while a copy of the documented discussion was only provided to 4.2% of patients. On the day of surgery, the benefits, risks and alternatives to the planned procedure were discussed in less than half of cases. This rate was similar across different clinician grades, while marked variation was seen across hospitals. Conclusion: In this prospective multi-centre study we have demonstrated wide variation in the consent processes in many surgical specialities across Scotland. Following the Montgomery ruling, we have demonstrated the current consent process in elective surgery is likely to be substandard, and may require additional steps to be taken by clinicians to ensure patients are fully informed to make decisions regarding their treatment.

AB - Background: The Montgomery ruling has had a wide-ranging impact on the consent process and has been the subject of new guidelines by bodies, including the Royal College of Surgeons (RCSEng). This is the first study to examine the current standard of consent for surgical procedures at a national level. Method: A national collaborative research model was used, with prospective data collection performed across hospitals in Scotland. Variables associated with the consent process were audited across three surgical specialities (general surgery, urology and orthopaedics) and measured against standards set by RCSEng, the Scottish Public Services Ombudsman and medical defence organisations. Results: A total of 289 cases were identified from 12 hospitals. The majority of patients were reviewed by a consultant surgeon in clinic (79.9%) or on the day of surgery (55.4%). The clinic consent rate was 27.0%, while a copy of the documented discussion was only provided to 4.2% of patients. On the day of surgery, the benefits, risks and alternatives to the planned procedure were discussed in less than half of cases. This rate was similar across different clinician grades, while marked variation was seen across hospitals. Conclusion: In this prospective multi-centre study we have demonstrated wide variation in the consent processes in many surgical specialities across Scotland. Following the Montgomery ruling, we have demonstrated the current consent process in elective surgery is likely to be substandard, and may require additional steps to be taken by clinicians to ensure patients are fully informed to make decisions regarding their treatment.

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