Informed consent processes with First Nations peoples undergoing surgery or invasive procedures: a scoping review.

Area of Science:

• Medical Ethics
• Indigenous Health
• Health Services Research

Background:

• Informed consent is crucial in medicine but often ethically compromised.
• Cultural differences in worldviews and health paradigms can hinder informed consent for First Nations peoples.
• The adequacy of informed consent for First Nations patients undergoing medical procedures is largely unknown.

Purpose of the Study:

• To map and analyze informed consent processes for First Nations peoples in Australia, New Zealand, and North America undergoing surgery or invasive procedures.
• To identify challenges and effective strategies for obtaining informed consent from First Nations patients.

Main Methods:

• A scoping review involving systematic searches of major databases and manual searches of grey literature.
• Analysis of informed consent processes against jurisdictional guidelines.
• Thematic analysis of First Nations peoples' experiences, impacts of gaps, healthcare staff views, and enhancement strategies.

Main Results:

• Nine qualitative studies revealed that informed consent processes often failed to meet guidelines.
• First Nations participants reported coercion due to racism and power imbalances, with physicians prioritizing their views over patient values.
• Inadequate consent processes led to fear, disengagement from health services, and negative impacts on well-being.

Conclusions:

• Informed consent forms are frequently signed without full understanding, exacerbated for First Nations peoples by language barriers, cultural health differences, and racism.
• Improved assessment, training, and quality improvement initiatives are needed to address gaps in informed consent.
• Partnership with First Nations peoples is essential for enhancing guidelines and ensuring true informed consent.