DISCUSSION:
The use of biological products in medicine has become routine but
remains controversial and the subject of debate.5Patients wish to know the derivative of any biological products that may
be used, which itself raises the issue of informed consent prior to
their use.1 Due to a patient’s ethical, religious or
personal beliefs the use of these biological products without consent is
morally flawed. Clinicians tend to underestimate the impact and
importance of religion in their patients’ lives and the implications of
this upon their care.11Sulmasy DP. The healer’s calling: a
spirituality for physicians and other health care professionals. New
York: Paulist Press; 1997 Ignoring the impact of religion on a
patient’s decision is likely to lead to a breakdown in the trust between
clinician and patient.22Silvestri GA, Knittig S, Zoller JS,
Nietert PJ. Importance of faith on medical decisions regarding cancer
care. J Clin Oncol 2003; 21:1379–1382.
Whilst religion remains a major influence on the objection of the
medicinal use of biological products, there has been an increase in
people who self-identify as vegan and also object to the use of animal
derived products. In a 2018 Ipsos Mori study commissioned byThe Vegan Society , the number of vegans in the United Kingdom had
increased from 0.25% of the population to 1.16% in 2018, which equates
to approximately 600,000 adults.33The Vegan Society. Food
and You Surveyhttps://www.vegansociety.com/my-account/the-vegan/issue-3-2018/survey
(Accessed 01/04/2020) This number may have increased further given
the recent publicity and awareness-raising campaigns promoting veganism
and vegetarianism. Of the biological products we have included within
this survey, only one product (Surgicel ) is plant-based, with the
remainder including a human or animal derivative. This can restrict
treatment options in those who specifically object to the use of
products of human or animal origin, potentially altering surgical
outcomes. Alongside this, we must not overlook that objection to the use
of biological products need not be driven by religious or dietary
motives but more a matter of personal ethical and moral principles.
This study has demonstrated that there is a lack of awareness amongst
surgeons of biological products and their derivatives, implying that
patients are also often unaware and thus may not be consented for their
use. This lack of awareness can be appropriately addressed by educating
clinicians, which can be delivered efficiently through educational
platforms such as e-learning modules. This notion is supported by 74%
of our cohort who agreed that further education was required in this
subject area (Table 5).
The design of this study may have given rise to a degree of participant
bias, as respondents may have been more likely to complete the survey if
they had sufficient knowledge within the field. A greater geographic
spread, as well as numbers in specialties other than general surgery/
vascular surgery and otolaryngology may have highlighted specific
deficits in knowledge.
Our results demonstrate that most participants in this study do not
routinely consent (81%) to the intra-operative use of biological
materials (Table 5). The authors hope that this study highlights
deficiencies in knowledge that results in potential compromise of the
consenting process for surgical procedures. A simple solution to this
would be for clinicians to increase their awareness in this area and to
incorporate an additional statement on the consent form which addresses
the potential intraoperative use of biological products and what their
derivatives may be.
CONCLUSION: Although the intra-operative use of biological materials has become
routine, the consent process does not reflect this. Patients wish to
know which products may be used during their procedure; however, this is
not being routinely discussed pre-operatively. This may partly be due to
a lack of awareness amongst surgeons of the contents of these products,
highlighting a need for increased education. The authors recommend that
the use of biological products should be added to a surgical consent,
allowing surgeons to have an open and transparent discussion, whilst
upholding their duty to ensure that their clinical practice is patient
centred. Modernising the current consent process to reflect the
development and use of surgical biological products will help to ensure
improved patient satisfaction, fewer future legal implications as well
as a better surgeon-patient relationship.
No further acknowledgements.