An audit of consent practices and perceptions of lumbar puncture, Botswana inpatient setting experience

Abstract

The epidemic of HIV/AIDS in sub-Saharan Africa has led to significant increases in the burden of meningitis, especially cryptococcal meningitis. Morbidity and mortality resulting from meningitis occur partly due to delays in performing lumbar punctures both for diagnostic and therapeutic purposes. This study was conducted with the primary objective of exploring the attitudes and concerns that patients have with regard to lumbar puncture, and also to assess current consenting practices of doctors with regard to lumbar puncture. Methods: A descriptive cross-sectional study was conducted in medical wards of Princess Marina Hospital, a tertiary hospital in Gaborone, Botswana. Data were collected by means of a questionnaire-based survey involving patients or their next of kin, and doctors. Other relevant information was obtained from patient charts. Data collection involved 12 patients and 23 doctors. Results: Of the 12 patients interviewed, four stated that the reasons for doing lumbar puncture (LP) were explained to them. One respondent stated that LP risks were mentioned, while two stated that they were given the option to refuse LP. Most patients’ possible reasons for refusal of LP was attributed to fear of pain. Five (42.7%) patients/next of kin had never heard of LP before, and most of the interviewed patients associated the procedure with death and paralysis, while none associated with meningitis or HIV. Twenty-two (95.7%) of 23 doctors stated that they routinely consent patients for LP, 11 (47.8%) mentioned risks, and nine (39.1%) stated that the patient has the option to decline the procedure. Only 26% of doctors routinely used local anaesthesia while 22% routinely asked for written consent. Conclusion: Contrasting responses between doctors and patients indicates a need for standard consenting practices among doctors. Also, patients’ attitudes and receptiveness to lumbar punctures can be improved through education on lumbar puncture indications, benefits, and risks.