Informed consent processes with First Nations peoples undergoing surgery or invasive procedures: a scoping review
Bibliographic record
Abstract
BACKGROUND: Informed consent is a cornerstone of medical practice, however, is not always ethically obtained. For First Nations people, this can be hindered by different worldviews and health paradigms. Although best practice entails consideration of patient's cultural beliefs and needs, the extent towhich informed consent is adequately obtained from First Nations patients is unknown. We aimed to conduct a scoping review to map and analyse informed consent processes with First Nations peoples in Australia, New Zealand and North America who are undergoing surgery or an invasive medical procedure. METHODS: A systematic search was conducted using PubMed, Web of Science, Embase and Health InfoNet. Google scholar and webpages of relevant medical organisations were manually searched. Descriptions of informed consent processes were analysed against the guidelines to obtaining informed consent of the respective jurisdictions in which the research was conducted. The experiences of First Nations people undergoing informed consent processes, impact of gaps, healthcare staff views and strategies to enhance informed consent were thematically analysed. RESULTS: Nine qualitative studies were included. Processes reported failed to address all the considerations stated in the respective guidelines. Participants reported feeling coerced due to racism and power imbalances. Physicians tended to prioritise what they thought was better over patient's cultural values and protocols. Inadequate processes resulted in fear, disengagement of health services and negative impact on wellbeing. Engagement of professional interpreters, use of diagrams and workforce training that fosters reflective practice were found to enhance informed consent. CONCLUSION: Evidence suggests that consent forms are often signed by patients who are not fully informed. For First Nations people, this is aggravated by language barriers, culturally different understanding of health and racism leading to coercion. Better assessment of informed consent processes with First Nations people, training and ongoing quality improvement are required to identify and address gaps. Partnership with First Nations people is required to enhance current guidelines and to develop strategies to ensure true informed consent.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | Metaresearch Domain: Methods · Genre: Review About the Canadian research system: yes · About a Canadian topic: yes | Systematic review | low |
| gpt | no category Domain: not available · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Systematic review | low |
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.196 | 0.516 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.006 | 0.006 |
| Bibliometrics | 0.028 | 0.028 |
| Science and technology studies | 0.005 | 0.008 |
| Scholarly communication | 0.010 | 0.016 |
| Open science | 0.005 | 0.009 |
| Research integrity | 0.009 | 0.005 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".