Publication:

Quality of the informed consent process in diabetic foot amputation surgery: a prospective multicenter study in Senegal

Background Informed consent represents a fundamental ethical and legal requirement in surgical practice, particularly in mutilating procedures such as lower-limb amputation for diabetic foot. In low-resource settings, several structural and sociocultural factors may limit the quality of the informed consent process.

Methods A prospective descriptive and analytical multicenter study was conducted from April to December 2022 in three teaching hospitals in Dakar, Senegal. Adult patients hospitalized for surgical management of diabetic foot were included. Data were collected using structured questionnaires completed by physicians and patients to evaluate socio-demographic characteristics, clinical data, and the quality of the informed consent process. The perceived quality of informed consent was categorized as favorable (excellent or average) or unfavorable (poor). Statistical analysis was performed using the Chi-square test with a significance level set at p<0.05.

Results A total of 109 patients were included with a mean age of 62.1±9.1 years. Most patients (92.7%) reported understanding their diagnosis. However, several deficiencies were identified in the consent process: insufficient information about complementary investigations (78.9%), prosthetic rehabilitation (61.5%), and lack of confidentiality during counselling (82.6%). Only 25.7% of patients reported complete satisfaction with the consent process. Interview duration longer than five minutes (p<0.001), clarity of information (p<0.001), physician empathy (p<0.001), and counselling conducted in a private consultation room (p=0.001) were significantly associated with a favorable perception of informed consent.

Conclusions The informed consent process for diabetic foot amputation remains suboptimal despite a generally positive physician-patient relationship. Improving communication, ensuring confidentiality, and allocating sufficient consultation time may significantly enhance the quality of informed consent in surgical practice.