a) Socio-demographic data

Patient code

Age

Address

Marital status

Educational level

Employment status

b) Informed-consent Questions (Modified Dr. Brezis Questionnaire)

1) Nature of the surgery (Pre-operative diagnosis + Surgical procedure)

Known name (3)

Known nature (1)

Unknown (0)

2) Evaluation of the consent form in the patient’s file by the principal investigator (content and signature)

Present signed (3)

Present unsigned (1)

Absent

3) Did you have enough time to think, seek advice and consult others before signing the form

Yes, well in advance (2)

No, or on the day of surgery (0)

4) Who brought the form to you and asked you to

sign it

Treating Ob/Gyn

Resident in Ob/Gyn

Other hospital staff

(nurse, anaesthesiologist)

5) Did you read the consent form before signing it?

Yes

Partially

No

6) Why did you not read the consent form? (open-ended)

7) Who accompanied you when you signed the consent form?

Spouse

Relative or Friend

Nobody

8) To what degree was the information you received about your procedure sufficient, clear and detailed?

It was sufficient, clear and detailed (3).

It was not sufficient, clear, and detailed (1).

I am not sure, or I received no explanation (0).

9) Did you receive an

Explanation of the treatment risks?

Yes (2)

No (0)

10) List any risks you remember as regards your surgery (qualitative)

11) Did any risks prompt you to consider refusing surgery? (qualitative)

12) Would you have wanted more explanation of these risks?

No

I am not sure

Yes

13) Did you receive an explanation about alternative options for this treatment? For example, were you told about other forms of therapy available

Yes (2)

No (0)

14) From whom did you receive most of the

explanations?

Consultant (treating) Ob/Gyn

Resident Ob/Gyn or Other hospital staff

I did not receive explanations

15) To what degree did you feel comfortable asking questions?

A lot

A little

Not at all

16) Who do you think made the final decision about the treatment?

Patient (2)

Patient and treating physician together (1)

Physician (0)

17) Would you have wanted to be more involved in the treatment decision? (qualitative)

18) To what degree are you satisfied with the process of deciding on the treatment?

Satisfied

Somewhat satisfied

Not satisfied at all

19) Were you asked whether you understood the explanation?

Yes

I do not remember

No

20) Could you repeat the explanation now?

Yes

I cannot remember

Somewhat I did not receive any explanation

21) Do you know any expected benefits from your surgery?

Known (2)

Unknown (0)

22) List these benefits (qualitative)

23) Will there have been consequences if you refused surgery?

Known (2)

Unknown (0)

24) List these consequences (qualitative)