Adequacy of consenting patients for computed tomography (CT) scans in a developing country: a survey of two academic hospitals in Johannesburg, South Africa

Abstract

INTRODUCTION South Africa presents a complex scenario with regard to patients consenting for medical procedures, because of the differing profiles of the population and the health care workers who perform the consenting procedures. AIM To evaluate consenting practice for CT scanning, within the South African tertiary referral setting and to determine if there are any associations between patient demographic profile and the level of understanding with the adequacy of consent. METHOD A prospective survey regarding consenting practices for CT scanning was performed in a form of an interview questionnaire in patients presenting to Chris Hani Baragwanath Academic and Charlotte Maxeke Johannesburg Academic hospitals. Determination of any associations between patient age, racial group, language and education was made with the level of understanding and adequacy of consent. RESULTS The survey was conducted on 117 patients; 86 from Charlotte Maxeke Johannesburg Academic Hospital and 31 from Chris Hani Baragwanath Academic Hospital. We found no significant association between gender and age category (p=0.11), racial group (p=0.17), education (p=0.26), home language (p=0.21) or residential area type (p=0.70). vi There was a significant, weak, association between age category and education (p=0.043; Cramer’s V=0.29). There was a significant, moderate association between the understanding of the language of consent and the home language of the patients (p=0.0013; phi coefficient=0.43). There was also some association between education and age. Just over 50% of patients felt that they had been given enough information and had had an opportunity to ask questions and only 33% had been offered an alternative to the CT scan. There was a significant difference in the mean adequacy of consent score with regards to racial group (p<0.0001), home language (p=0.0073), residential area type (p<0.0001) and level of education (p<0.0001). CONCLUSION Language differences between patients and personnel performing the consent procedure proved to be a major barrier in offering adequate consenting for CT Scans.