Surgical consent practice in the UK following the Montgomery ruling: A national cross-sectional questionnaire study

Chris McKinnon; Dafydd Loughran; Roísín Finn; Madeline Coxwell-Matthewman; Deva Sanjeeva Jeyaretna; Adam P Williams

doi:10.1016/j.ijsu.2018.05.016

Surgical consent practice in the UK following the Montgomery ruling: A national cross-sectional questionnaire study

Int J Surg. 2018 Jul:55:66-72. doi: 10.1016/j.ijsu.2018.05.016. Epub 2018 May 26.

Authors

Chris McKinnon¹, Dafydd Loughran², Roísín Finn³, Madeline Coxwell-Matthewman⁴, Deva Sanjeeva Jeyaretna⁵, Adam P Williams⁶

Affiliations

¹ Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK; Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK. Electronic address: chris.mckinnon@nhs.net.
² St Cadoc's Hospital, Aneurin Bevan University Health Board, Newport, NP18 3XQ, UK.
³ Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
⁴ University College Hospital, University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK.
⁵ Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK; Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
⁶ Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK; Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK.

PMID: 29775736
DOI: 10.1016/j.ijsu.2018.05.016

Abstract

Background: The Supreme Court case of Montgomery vs Lanarkshire Health Board in 2015 was a landmark case for consent practice in the UK which shifted focus from a traditional paternalistic model of consent towards a more patient-centered approach. Widely recognised as the most significant legal judgment on informed consent in the last 30 years, the case was predicted to have a major impact on the everyday practice of surgeons working in the UK National Health Service (NHS). Two years after the legal definition of informed consent was redefined, we carried out an audit of surgical consent practice across the UK to establish the impact of the Montgomery ruling on clinical practice.

Materials & methods: Data was collected by distribution of an electronic questionnaire to NHS doctors working in surgical specialities with a total of 550 respondents.

Results: 81% of surgical doctors were aware of the recent change in consent law, yet only 35% reported a noticeable change in the local consent process. Important barriers to modernisation included limited consent training, a lack of protected time for discussions with patients and minimal uptake of technology to aid decision-making/documentation.

Conclusions: On the basis of these findings, we identify a need to develop strategies to improve the consent process across the NHS and limit the predicted rise in litigation claims.

Keywords: Complications; Healthcare; Informed consent; Risk; Surgery.

MeSH terms

Cross-Sectional Studies
Decision Making
Humans
Informed Consent / legislation & jurisprudence*
Practice Patterns, Physicians' / legislation & jurisprudence*
State Medicine / legislation & jurisprudence*
Surgeons / psychology*
Surveys and Questionnaires
United Kingdom