Are Patients Informed When They Consent to ERCP?

Abstract

BACKGROUD: Only the British Society of Gastroenterology has published consent guidelines that are inclusive for endoscopic retrograde cholangiopancreatography (ERCP). Previous research has shown that there are variations in the information discussed with patients who are undergoing ERCP.PURPOSE: To examine the informed consent practices for ERCP in Ontario.METHODS: A self-report questionnaire was sent to ERCP endoscopists in Ontario, who were identified through a pre-existing database. The 14-item questionnaire included questions pertaining to the risks, benefits and alternatives discussed, how consent was obtained and whether the consent process was modified for patients older than 75 years.RESULTS: Of the 82 surveys sent, 36 responses were received, with three respondents indicating that they no longer performed ERCP; the total response rate was 40%. Ninety-four per cent of those who responded noted that they obtained written consent, and 6% obtained verbal consent. When discussing risks with their patients, 91% of respondents always mentioned pancreatitis, 88% always mentioned bleeding, 73% always mentioned perforation and 30% always mentioned the risk of infection; only 24% always mentioned the possibility of being allergic to the contrast agent, and 73% rarely or never mentioned death. When dealing with patients older than 75 years, 38% of respondents tended to be more brief in their explanations, 31% gave the same details in their explanation and 31% gave more detailed information than they gave to younger patients. Seventy-nine per cent mentioned the possibility of diagnostic failure and 82% mentioned the possibility of therapeutic failure, while only 27% mentioned the possibility of missing a diagnosis.CONCLUSIONS: Variability exists in terms of ‘important information’ given to patients undergoing ERCP. Standard informed consent guidelines specific to ERCP may help endoscopists uphold their responsibility to the patient, enhance patient understanding and reduce the risk of liability.