CONFLICTS BETWEEN PHYSICIANS AND PATIENTS IN NON-ELECTIVE CESAREAN DELIVERY - INCIDENCE AND THE ADEQUACY OF INFORMED CONSENT

A study was undertaken in 372 consecutive patients undergoing non-elec tive cesarean delivery to explore the incidence and nature of conflict s between physician and patient surrounding the decision to undergo no n-elective cesarean delivery; to examine the adequacy of informed cons ent at the time of non-elective cesarean delivery; and to describe the importance of a preventive ethics approach to non-elective cesarean d elivery. During a 6-month interval, all patients who underwent non-ele ctive cesarean delivery and their physicians were asked to take part i n a survey in the early postpartum period concerning their response to recommendations for cesarean delivery. The survey included demographi cs as well as questions pertaining to informed consent and the presenc e and nature of patient-physician conflict. Of the 326 patients who we re interviewed, 319 (98%) agreed to the recommendation for non-electiv e cesarean delivery and 7 patients (2%) initially disagreed. Reasons f or disagreeing included: feared surgery (4 of 7), needed husband's app roval (1 of 7), and questioned the medical necessity of surgery (2 of 7). In all 7 cases of initial disagreement, cesarean delivery was even tually performed with the patient's consent. The mean age of patients who initially disagreed was younger (24.7+/-6) than that of those who agreed (31.0+/-4 [p<0.05]). Conflicts were present in 7 of 113 clinic patients and 0 of 213 private patients (p<0.05). Of those surveyed, 26 (8.7%) indicated that they did not have adequate input in the decisio n for non-elective cesarean delivery. Patients with inadequate input e xpressed significantly more concerns with regard to the effect of surg ery on their own health (p<0.05) as well as its effect on the baby (p< 0.05). Our findings suggest that even though the incidence of physicia n-patient conflict about non-elective cesarean delivery was quite low, a significant number of patients (1 in 12) may have reservations conc erning the informed consent process at the time of non-elective cesare an delivery. Patients with reservations are more likely to have greate r concerns with regard to maternal and fetal risks, suggesting that a more detailed risk disclosure prior to the procedure is warranted for all pregnant patients. Perhaps by incorporating the preventive strateg ies discussed, the adequacy of informed consent and therefore the pati ent's autonomy could be enhanced, thus diminishing patient reservation s and preventing physician-patient conflict in the intrapartum period.