A questionnaire was distributed in Queen's Medical Centre in Nottingham, the Royal Sussex County Hospital in Brighton and Eastbourne District General Hospital in Eastbourne during 2007 to a randomly selected cohort of anonymous anaesthetists and surgeons. The cohort consisted of those surgeons and anaesthetists present during theatre lists in main theatre suites at the respective hospitals over a 2 week period. The questionnaire was made up of 35 statements that addressed issues concerning consent for anaesthesia and surgery [Additional File 1
]. The participants were asked to what extent they agreed with statements about consent on a five point Likert scale [19
]; 'five' indicated complete agreement with the statement and 'one' showed complete disagreement. The statements in the questionnaire were grouped as follows:
1. Eight statements regarding the main purposes of the consent process
2. Seven statements related to why consent may be unnecessary
3. Seven statements related to what should be explained during the consent process
4. Six statements related to the factors which affect the amount of information given to patients during the consent process
5. Seven statements related to the levels of major and minor risks that should be disclosed during the process of consent
Our primary hypothesis was that both surgeons and anaesthetists should agree with the following statements:
1. Respect for a patient's right to autonomy is one of the main purposes of the consent process
2. That consent process maybe inappropriate as most patients do not usually remember all the information given to them during the consent process
3. That what the procedure aims to achieve should be explained to the patient as part of the consent process
4. That the complexity of the procedure affects the amount of information conveyed to the patient during the consent process
The questions related to the primary hypothesis were identified as important themes from the consent guidelines. They were asked in the middle of the questionnaire, and were not identified as such, to avoid unintended bias in the answers.
The local ethics committee waived the requirement for formal ethical approval because our study comprised an anonymised questionnaire; individuals provided consent by completing the questionnaire.
Before use, the questionnaire was piloted with ten medical students. This pilot highlighted grammatical ambiguities that were corrected for the final version of the questionnaire. This was re-examined by the pilot cohort before distribution to the participants. Face-to-face interviews were conducted with the initial pilot cohort to check that written responses reflected the respondents meaning and intent; there were no discrepancies.
The intended participants in this survey were consultants, registrars and senior house officers (SHO) in anaesthesia and surgery, of both sexes and varying age and years of experience, who were working at the Queen's Medical Centre in Nottingham, the Royal Sussex County Hospital in Brighton and Eastbourne District General Hospital in Eastbourne during 2007.
Analysis of data was undertaken using Statistical Package for Social Sciences, Version 15.0 (Chicago, Illinois, USA). Raw data was analysed by taking answers of 1 and 2 on the Likert scale to indicate disagreement with the given statement while answers of 4 and 5 to indicate agreement.
The reliability and validity of the questionnaire was assessed by calculating the correlation statistics for intra and inter questionnaire groups of questions. The inter-group correlation co-efficient was calculated by comparing the responses to the four questions of the primary hypothesis.