Barriers to consent taking in ECT

Abstract

Introduction

There were 16,482 administrations of Electro-convulsive Therapy (ECT) to 2835 individuals in England between January-March 1999. Controversy still surrounds the safety, ethics and necessity of ECT with some patients reporting severe adverse effects and feeling particularly strongly about it being administered without their consent. NICE guidelines along with the ECT accreditation service (ECTAS) sought to address these concerns and raise standards for ECT in UK.

Aims and Objective

To identify any barriers to compliance with NICE guidelines regarding consent for ECT.

Methods

All patients newly started on ECT during a 3 month period at Hellesdon Hospital were enrolled into this study. Case notes were analysed for 16 patients against the 21 standard ECTAS consent criteria.

Results

The hospital rated good (70–89%) or excellent (90–100%) for all guidance except the one which requires patients to complete some sections of the consent form. Only 63% of the patients had completed these, however 100% went on to sign the consent form before every session. Guidance compliance was excellent for 15 (72%) of items examined.

Conclusions

There is good compliance with NICE guideline relating to consent for ECT. The only barrier to full compliance was inadequate documentation by patients in some sections. Steps to improve patient participation can now be implemented. This will provide assurance that ECT is used appropriately and that the process fully enables informed consent. Further research is required to discover the reasons for unsatisfactory patient participation in the consent process.