Date of Award

1-1-2018

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Vrunda B. Desai

Abstract

While there has been a shift in the view of informed consent over the past half century from a paternalistic legal protection to a shared decision that supports patient autonomy and the patient-doctor relationship, these theoretical changes have not been successfully operationalized. Repeat Cesarean Section (CS) is a scheduled procedure with a complex risk-benefit profile, and thus is an excellent lens through which to assess the quality and timing of informed consent documents. A chart review of informed consent documents for repeat Cesarean Section for six weeks from March 20th, 2017 to April 30th, 2017 was conducted (n=62). While all but one case in the sample had documented informed consent, there were significant differences with regards to documentation of risk and timing. Though bleeding (95%), infection (96%), and damage to adjacent structure (95%) were recorded in almost all cases, other risks such as need for hysterectomy (49%), abnormal placentation (49%), and need for cesarean section in subsequent pregnancy (40%) were documented less than half the time. Other maternal risks and fetal risks were rarely mentioned. Risks were more frequently documented by residents than attending physicians (5.6 v 3.2, p

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