Clinicians’ perceptions of pediatric assent for invasive Bedside procedures at three tertiary referral Hospitals in Nairobi county, Kenya.
Date of Award
Master of Medicine (MMed)
Dr. Angela Migowa
Dr. John Weru
Mr. James Orwa
Paediatrics and Child Health (East Africa)
Background: The medical profession is built on the foundation of morals and ethics guided by principles of beneficence, non- maleficence, autonomy and justice. In order for an individual to be sufficiently autonomous, the value of information is indispensable. The information allows the patient to make an informed decision concerning their healthcare. The patient then gives an informed consent or assent as is applicable to the pediatric population. Majority of the studies surrounding pediatric assent revolves around obtaining it for research. There is a paucity of literature in regards to pediatric assent for clinical treatment more so as regards clinicians’ perceptions towards the same. Local data pertaining to clinicians’ perceptions towards pediatric assent for invasive bedside procedures is lacking hence this necessitated a study that would help to shape the context of pediatric assent in clinical practice in Kenya.
Methods: The study was a descriptive mixed method cross sectional study carried out among clinicians working in the pediatric units including consultants, nurses, medical officers and pediatric residents at Aga Khan University Hospital (AKUH), Kenyatta National Hospital (KNH) and Gertrudes Children Hospital (GCH) between July 2020 and June 2021. It entailed a filling in a self-administered pre-tested questionnaire for the quantitative part and participation in a semi-structured interview for the qualitative part to assess the clinicians’ perceptions of pediatric assent for invasive bedside procedures. The analysis of perceptions was achieved by creation of a composite variable termed perception index score based on the median score as high or low and the results further supported by quotes from the qualitative study that were coded into relevant themes. Associations between predictor and outcome variables were analyzed using chi square test and logistic regression used to analyze the significant factors that emerged from the chi square test.
Results: There were 241 participants for the quantitative study and 22 participants for the qualitative study. Seventy five percent of the participants were familiar with the term assent and its importance within the pediatric population. A high perception index score was noted among 50.2% of the participants most of whom were mostly female (77%). The median perception index score was 57 out of a total of 66. Despite being familiar with the concept of assent, 67.2% of the participants would still proceed with an invasive bedside procedure even if the child dissented. The median age for seeking assent was 8 years (IQR:6-13). Up to 72.6% (175 out of 241) of the participants in the qualitative arm were not aware of any local laws or guidelines informing the practice of assent. There was an association between a high perception index score and the participants’ gender (p=0.029), work department (p=0.004) and professional cadres (p=0.010). Upon multivariate analysis, a high perception score was significantly associated with the female gender (aOR: 2.40, 95% CI: 1.29–4.46) and working in both inpatient and outpatient departments as compared to working in either department.
Conclusions: Three out of every four participants in the quantitative study were familiar with the concept of assent. Despite being aware of what it entails, 67.2% would still proceed with an invasive bedside procedure despite the child dissenting especially if the parent had already consented and if the benefits outweigh the risks as qualified by supportive quotes form the qualitative study. A major gap identified is the lack of knowledge regarding the local laws and guidelines that inform on the practice of obtaining assent in clinical practice from both arms of the study. As a result, many of the participants in the qualitative study viewed assent to be important in terms of informing the child about a procedure at the clinician’s discretion but not as an important component of decision making in clinical practice.
Omondi, G. O. (2021). Clinicians’ perceptions of pediatric assent for invasive Bedside procedures at three tertiary referral Hospitals in Nairobi county, Kenya. (Unpublished master's dissertation). Aga Khan University, East Africa.