Informed consent and medical ordeal: a qualitative study.
BACKGROUND
Informed consent is a mainstay of clinical practice, with both moral and legal forces. Material disclosure about extreme treatments, however, is unlikely to convey the full impact of the experience of treatment. Informed consent may be flawed under such circumstances. The aims of this study were to compare expressed satisfaction with pretreatment information to satisfaction after experiencing autologous stem cell transplantation for recurrent lymphoma.


METHODS
A qualitative, narrative-based cohort study was conducted in a bone-marrow transplant unit of a teaching hospital at Westmead Hospital, Sydney, Australia. The cohort consisted of 10 transplant recipients and 9 of their nominated lay carers. The outcome measure was satisfaction expressed in narrative interviews at the time of transplantation and 3 months later. We used discourse-analytic techniques to examine the narratives.


RESULTS
Both patients and carers expressed high satisfaction with the information given by individual clinicians and by speakers at a formal Information Day held before transplantation. At the first interview, neither patients nor carers commented much on the forthcoming ordeal of chemotherapy and bone marrow ablation, although all patients had undergone previous chemotherapy. At the second interview, the ordeal dominated the narratives and retrospective dissatisfaction with information was common.


CONCLUSIONS
This study suggests that information about treatment theories and protocols can be satisfactorily communicated, but personal experience of suffering defies communication. This finding has serious implications for the practices involved in obtaining informed consent and for the very notion of informed consent.
Little
M
M
Centre for Values, Ethics and the Law in Medicine, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia. milesl@ozemail.com.au
Jordens
C F C
CF
McGrath
C
C
Montgomery
K
K
Lipworth
W
W
Kerridge
I
I
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000592:standards; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D036301:Qualitative Research; D033581:Stem Cell Transplantation / Q000379:methods / Q000592:standards