The effect of the institutionalization of medical care on quality of patient's informed consent
by Constantine, Melissa L., Ph.D., UNIVERSITY OF MINNESOTA, 2008, 230 pages; 3295682

Abstract:

Objectives. Informed Consent is an integral part of healthcare delivery in the U.S., and is expected to be obtained from patients prior to performing most medical procedures. This study aimed to construct and measure a multi-dimensional model of informed consent (IC), that includes measurement of Intention, Understanding and Controlling Influence, and to evaluate IC for women in the context of prenatal screening. This study also aims to model and measure the characteristics of an institutionalized medical procedure (the prenatal screen) and evaluate the effects of the institutionalization of this procedure on patient IC for the procedure.

Methods. Obstetrician's (n=31) and their patients (n=273) at ten obstetrics practices were asked to fill out questionnaires at the time the blood draw for the prenatal screen would occur. The primary outcome measure is whether criteria of informed consent (intention, understanding, freedom from controlling influence) for the screen was met. Further analysis evaluates the relationship between the characteristics of the screen as an institutionalized medical procedure and IC.

Results. Fifty seven percent of patient respondents do not give a consent that is considered an informed consent. The criteria for Intention is not met for 31% of respondents, the criteria for Understanding is not met for 45% of respondents and 8% of respondents experience some form of Controlling Influence. Patient perception of the prenatal screen as something that is performed routinely, without need for deliberation, is a predictor of IC not being met.

Conclusion. Informed consent not being given by 57% of patients for a procedure that is considered standard for all pregnant women. This research indicates a need for improvement in obtaining informed consent or informed refusal for prenatal screening, and also suggests that it is the very routine and standard nature of the screen that may be a factor in compromised IC for the screen. Continued and further evaluation of the quality of informed consent for both routine and non-routine medical procedures in clinical practice is warranted.

 
AdviserTodd H. Rockwood
SchoolUNIVERSITY OF MINNESOTA
SourceDAI/B 69-01, p. , Mar 2008
Source TypeDissertation
SubjectsObstetrics and gynecology; Public health; Health care management
Publication Number3295682
Adobe PDF Access the complete dissertation:
 

» Find an electronic copy at your library.
  Use the link below to access a full citation record of this graduate work:
  http://gateway.proquest.com/openurl%3furl_ver=Z39.88-2004%26res_dat=xri:pqdiss%26rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation%26rft_dat=xri:pqdiss:3295682
  If your library subscribes to the ProQuest Dissertations & Theses (PQDT) database, you may be entitled to a free electronic version of this graduate work. If not, you will have the option to purchase one, and access a 24 page preview for free (if available).

About ProQuest Dissertations & Theses
With over 2.3 million records, the ProQuest Dissertations & Theses (PQDT) database is the most comprehensive collection of dissertations and theses in the world. It is the database of record for graduate research.

The database includes citations of graduate works ranging from the first U.S. dissertation, accepted in 1861, to those accepted as recently as last semester. Of the 2.3 million graduate works included in the database, ProQuest offers more than 1.9 million in full text formats. Of those, over 860,000 are available in PDF format. More than 60,000 dissertations and theses are added to the database each year.

If you have questions, please feel free to visit the ProQuest Web site - http://www.proquest.com - or call ProQuest Hotline Customer Support at 1-800-521-3042.