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Observational Study
. 2025 Feb;107(2):151-156.
doi: 10.1308/rcsann.2024.0016. Epub 2024 May 15.

Adherence to General Medical Council guidance regarding disclosure of alternative treatments during the consent process

G S Bethell  1   2 , R A Wheeler  2 , N J Hall  1   2
Affiliations
Observational Study

Adherence to General Medical Council guidance regarding disclosure of alternative treatments during the consent process

G S Bethell et al. Ann R Coll Surg Engl. 2025 Feb.

Abstract

Introduction: General Medical Council (GMC) guidelines dictate that reasonable alternatives to treatment should be disclosed during the consent process. We aimed to determine whether GMC guidelines on disclosure of alternatives during consent are being followed in a real-world example which is disclosure of non-operative management as an alternative to appendicectomy in uncomplicated paediatric appendicitis.

Methods: We undertook a retrospective single-centre observational study and national consultant specialist paediatric surgeon survey. Two groups of 50 consecutively treated children (<16 years) with acute uncomplicated appendicitis were included in the observational study during two periods. UK-based consultant surgeons who treat appendicitis were included in the national survey. The main outcomes were disclosure and use of non-operative management (NOM) as an alternative to appendicectomy.

Results: Overall, in the observational study, NOM was disclosed in 30 (30%) children and 77% (23/30) opted for this treatment method when it was disclosed. There were 83 survey respondents representing all 25 eligible specialist paediatric surgery centres. Ten (12%) consultants reported routinely offering NOM, 39 (47%) offer it in select circumstances, and 34 (41%) never offer NOM. Only 25 (30%) respondents always disclose NOM as an alternative to appendicectomy, whereas 22 (27%) never do. Consultants who never disclose NOM are more likely to prefer appendicectomy over NOM compared with those who always disclose it (p<0.001).

Conclusion: In this illustrative clinical scenario, observed and reported practice regarding disclosure of alternative treatments during the consent process do not meet GMC guidance. This risks depriving children and caregivers of a choice that they are entitled to.

Keywords: Appendicitis; General Medical Council; Informed consent.

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Figures

Figure 1
Figure 1
Respondents' reported practice regarding disclosure of an alternative to appendicectomy with a selection of free-text explanations for their response
Figure 2
Figure 2
Respondents' reported practice regarding shared decision making with children and caregivers with a selection of free-text explanations for their response
Figure 3
Figure 3
Use of, disclosure of and shared decision making regarding non-operative management (NOM) comparing (a) male vs female respondents, (b) least vs most consultant experience and (c) participation v non-participation in a randomised controlled trial of NOM in paediatric uncomplicated appendicitis
Figure 4
Figure 4
Preferred treatment strategy of survey respondents stratified by their practice regarding disclosure of an alternative to appendicectomy (p<0.001). Each symbol represents an individual response and vertical lines are medians
See this image and copyright information in PMC

References

    1. General Medical Council (GMC). Guidance on professional standards and ethics for doctors decision making and consent. https://www.ridout-law.com/new-gmc-guidance-on-decision-making-and-consent/ (cited November 2023).
    1. Wheeler R. The evolution of informed consent. Br J Surg 2017; 104: 1119–1120. - PubMed
    1. Montgomery v Lanarkshire Health Board (Scotland) UKSC 11. https://en.wikipedia.org/wiki/Montgomery_v_Lanarkshire_Health_Board (cited January 2025).
    1. Barry MJ, Edgman-Levitan S. Shared decision making–pinnacle of patient-centered care. N Engl J Med 2012; 366: 780–781. - PubMed
    1. Svensson JF, Patkova B, Almstrom Met al. . Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg 2015; 261: 67–71. - PubMed

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