Perkütanöz Karaciğer Biyopsisi Hasta Deneyimlerini Anlamak Hekimleri Yasal Yaptırımlardan Koruyabilir

Öz

Amaç: Karaciğer biyopsisi karaciğer parankim hastalıkları tanısında altın standart tanı yöntemidir. Karaciğer biyopsisi hasta deneyiminin tanımlanması şu sebeplerden dolayı önemlidir; hastaların hastalık yönetimine katılım ve uyumlarının arttırılması, sağlık sunumu kalitesinin arttırılması, yüksek hasta memnuniyetinin sağlanması ve hekimlerin yasal sorumluluklara maruz kalmaması. Yöntem: Üçüncü basamak sağlık kuruluşu gastroenteroloji kliniğinde Ağustos 2020 -Eylül 2021 tarihleri arasında karaciğer biyopsisi uygulanan hastalar bu prospektif kohort çalışmasına dahil edildi. Biyopsi süreci deneyimlerini değerlendirmek için karaciğer biyopsisi sonrası gözlem süresini tamamlayan hastalara 14 soruluk bir deneyim anketi uygulandı. Anket formları anonim olarak dizayn edildi ve hastalardan anket toplama kutusuna bırakmaları istendi. Bulgular: Çalışmaya yaş ortalaması 44±13 olan toplam 128 hasta dahil edildi. Anket cevaplama oranı %84 olarak gerçekleşti. Karaciğer biyopsisi en sık 63 (%48,8) hepatit B enfeksiyonu endikasyonu ile gerçekleştirilmişti. Karaciğer biyopsi hastaların 126’sında (%98,8) teknik olarak başarılı oldu. Hastaların 122’si (94,5%) biyopsinin neden gerekli olduğu hakkında yeterli bilgi aldığını beyan etmişti fakat işlem hakkında teknik bilgiyi 112 hasta (%86,8) ve işlemin risklerinin açıklanmasını 94 hasta (%72,8) yeterli gördü. Bilgilendirilmiş onam formunun tamamını hastaların yalnızca %36’sı okurken %35,1’i göz gezdirmiş, %27,4’ü ise hiç okumamıştı. Sonuç: Hastalara sağlık sunumu gerçekleştirenler tarafından işlemin gerekliliği ve riskleri açısından yeterli bilgi verilmektedir. Fakat hastaların sadece üçte biri bilgilendirilmiş onam formunun tamamını imzalamadan önce okuduğunu ifade etmektedir. Bu noktada hekim tarafından kapsamlı bir sözel bilgilendirme yapılması medikolegal sorunları önlemede fayda sağlayabilir.

Anahtar Kelimeler

• Hasta uyumu
• Tıbbi sorumluluk
• Karaciğer hastalıkları
• biyopsi

Understanding Percutaneous Liver Biopsy Patient Experiences May Protect Physicians from Legal Action

Öz

Objective: Liver biopsy is the gold standard modality in the diagnosis of parenchymal liver diseases. It is important to define liver biopsy patient experience for the following reasons; to increase the participation and compliance of patients in disease management, to increase the quality of health care, to ensure high patient satisfaction, and to prevent physicians from being exposed to legal responsibilities. Methods: Patients who underwent liver biopsy in a tertiary healthcare institution gastroenterology clinic were included in this prospective cohort study between August 2020 and September 2021. In order to evaluate the experience through liver biopsy, an experience questionnaire including 14 questions was applied to patients who completed the monitorization after liver biopsy. Questionnaire forms were anonymous, and patients were asked to leave in the collection box. Results: A total of 128 patients with a mean age of 44±13 were included in the study. The survey response rate was 84%. The most frequently detected reason of biopsy was Hepatitis B infection in 63 (48.8%) patients. Liver biopsy was technically successful in 126 (98.8%) patients. Totally 122 (94.5%) patients declared that they had sufficient information about why biopsy was necessary, 112 patients (86.8%) found the technical information about the procedure was sufficient and 94 patients (72.8%) considered the explanation of the risks of the procedure was adequate. However, only 36% of patients read the entire informed consent form, 35.1% had a look at it, 27.4% had never read it. Conclusion: Adequate information is given to patients by healthcare providers regarding the necessity and risks of the procedure. However, only one-third of the patients stated that they read the entire informed consent form before signing it. At this point, a comprehensive verbal information given by the physician may be beneficial in preventing medicolegal problems.

Anahtar Kelimeler

• Liver diseases
• biopsy
• patient compliance
• medical liability

Kaynakça

1. Myers RP, Fong A, Shaheen AAM. Utilization rates, complications and costs of percutaneous liver biopsy: a population based study including 4275 biopsies. Liver Int. 2008;28(5):705-712.
2. Sheela H, Seela S, Caldwell C, Boyer JL, Jain D. Liver biopsy: evolving role in the new millennium. J Clin Gastroenterol. 2005;39(7):603-610.
3. Huang J-F, Hsieh M-Y, Dai C-Y, et al. The incidence and risks of liver biopsy in non-cirrhotic patients: An evaluation of 3806 biopsies. Gut. 2007;56(5):736-737.
4. Rustagi T, Newton E, Kar P. Percutaneous liver biopsy. Trop Gastroenterol. 2010;31(3):199-212.
5. Perrault J, McGill DB, Ott BJ, Taylor WF. Liver biopsy: complications in 1000 inpatients and outpatients. Gastroenterology. 1978;74(1):103-106.
6. Seeff LB, Everson GT, Morgan TR, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol. 2010;8(10):877-883.
7. Firpi RJ, Soldevila–Pico C, Abdelmalek MF, Morelli G, Judah J, Nelson DR. Short recovery time after percutaneous liver biopsy: should we change our current practices? Clin Gastroenterol Hepatol. 2005;3(9):926-929.
8. Van der Poorten D, Kwok A, Lam T, et al. Twenty‐year audit of percutaneous liver biopsy in a major Australian teaching hospital. Intern Med J. 2006;36(11):692-699.

9. Gilmore IT, Burroughs A, Murray-Lyon IM, Williams R, Jenkins D, Hopkins A. Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut. 1995;36(3):437-441.
10. Sharma P, Dhawan S, Bansal R, et al. The usefulness of transient elastography by FibroScan for the evaluation of liver fibrosis. Indian J Gastroenterol. 2014;33(5):445-451.
11. Poynard T, McHutchison J, Manns M, Myers RP, Albrecht J. Biochemical surrogate markers of liver fibrosis and activity in a randomized trial of peginterferon alfa-2b and ribavirin. Hepatology.2003;38(2):481-492. doi:10.1053/jhep.2003.50319
12. Ziol M, Handra-Luca A, Kettaneh A, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41(1):48-54. doi:10.1002/hep.20506
13. Bonder A, Afdhal N. Utilization of FibroScan in clinical practice. Curr Gastroenterol Rep. 2014;16(2):1-7.
14. Novy DM, Price M, Huynh PT, Schuetz A. Percutaneous core biopsy of the breast: correlates of anxiety. Acad Radiol. 2001;8(6):467-472.
15. Loeb S, Vellekoop A, Ahmed HU, et al. Systematic review of complications of prostate biopsy. Eur Urol. 2013;64(6):876-892.
16. Fernández-Salazar L, Velayos B, Aller R, Lozano F, Garrote JA, González JM. Percutaneous liver biopsy: patients’ point of view. Scand J Gastroenterol. 2011;46(6):727-731.
17. Cupples SA. Effects of timing and reinforcement of preoperative education on knowledge and recovery of patients having coronary artery bypass graft surgery. Hear lung J Crit care. 1991;20(6):654-660.
18. Campbell MS, R. Reddy K. The evolving role of liver biopsy. Aliment Pharmacol Ther. 2004;20(3):249-259.
19. Aharony L, Strasser S. Patient satisfaction: what we know about and what we still need to explore. Med Care Rev. 1993;50(1):49-79.
20. Bhutta ZA. Beyond informed consent. Bull World Health Organ. 2004;82:771-777.
21. Millum J, Bromwich D. Informed consent: What must be disclosed and what must be understood? Am J Bioeth. 2021;21(5):46-58.
22. Sönmez MG, Kozanhan B, Özkent MS, et al. Evaluation of the readability of informed consent forms used in urology: Is there a difference between open, endoscopic, and laparoscopic surgery? Turkish J Surg. 2018;34(4):295.
23. Ögün MN, Önerli M, Türkoğlu ŞA, Yıldız S. Informed Consent in Diagnostic and Therapeutic Lumbar Puncture: Are Patients Aware of the Risks? Turk J Neurol. 2019;25:229-232.
24. Bassi A, Brown E, Kapoor N, Bodger K. Dissatisfaction with consent for diagnostic gastrointestinal endoscopy. Dig Dis. Sci. 2002;20(3-4):275-279.
25. Flam B, Spice-Cherry P, Amsel R. Effects of preparatory information of a myelogram on patients’ expectations and anxiety levels. Patient Educ Couns. 1989;14(2):115-126.
26. Pernotto DA, Bairnsfather L, Sodeman W. “ Informed consent” interactive videodisc for patients having a colonoscopy, a polypectomy, and an endoscopy. Medinfo. 1995;8:1699.
27. Pereira SP, Hussaini SH, Wilkinson ML. Informed consent for upper gastrointestinal endoscopy. Gut. 1995;37(1):151-153.
28. Shepherd HA, Bowman D, Hancock B, Anglin J, Hewett D. Postal consent for upper gastrointestinal endoscopy. Gut. 2000;46(1):37-39.
29. Wysong PR, Driver E. Patients’ perceptions of nurses’ skill. Crit Care Nurse. 2009;29(4):24-37.
30. Rad MP, Abbasi B, Morovatdar N, Sadeghi M, Hashemi K. Pain in percutaneous liver core-needle biopsy: a randomized trial comparing the intercostal and subcostal approaches. Abdom Radiol. 2019;44(1):286-291.
31. Mahadeva S, Mahfudz AS, Vijayananthan A. Ethnicity influences pain after ultrasound-guided percutaneous liver biopsy. Eur J Gastroenterol Hepatol. 2015;27(12):1378-1381.
32. Riley TR. Predictors of pain medication use after percutaneous liver biopsy. Dig Dis Sci. 2002;47(10):2151-2153.
33. Eisenberg E, Konopniki M, Veitsman E, Kramskay R, Gaitini D, Baruch Y. Prevalence and characteristics of pain induced by percutaneous liver biopsy. Anesth Analg. 2003;96(5):1392-1396.