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

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.

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.

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.

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.