What is sufficient and why informed consent so important for patient care?
Why do health practitioners generally have problems in this area?
Consent is a basic legal principle that reflects a person’s agreement to something. In a healthcare context it means a person’s agreement to something being performed on them or a sample being taken from them.
Informed consent, in a legal sense, reflects that a patient has received the information relevant to them to make an informed decision and they have given permission for the healthcare to be provided. In an ethical sense the provision of informed consent by a patient reflects the end point of a process of engagement in which one or more health practitioners have supported the patient to come to an informed decision to agree to the healthcare offered.
Patient-centred care is widely recognised as a core dimension of a quality modern health service. Informed decision-making – a two-way dialogue between patients and their health practitioners about the benefits, risks and alternatives of treatment, taking into account the patient’s personal circumstances, beliefs and priorities – is vital to truly patient-centred care.
A well informed patient can be an active partner in decision-making about their care, with realistic expectations about the likely or potential outcomes of their treatment and an additional layer of vigilance and protection against errors or adverse events. Performed well, the informed decision-making process builds trust, prevents harm and reduces surprise and distress if complications or adverse events occur.
While consent forms are often necessary for risk management, completing the form is the final step in documenting the patient’s decision about consent; it is not the entire informed decision-making process. Patients need to be given sufficient information to enable them to make informed decisions about their healthcare.
Notes of consent discussions often simply say something like ‘risks discussed’.
Practitioners should consider the following;
- Nature of the problem
- Proposed treatment including the expected benefits, common side effects and alternative healthcare options
- Risks of treatment
- Approximate likelihood of risks (eg. High risk or moderate risk)
- Assessment of the patient’s understanding of the proposed treatment
- Noting that the patient was given the opportunity to ask questions
For particular risky or complex treatments a fact sheet or brochure should be given to the patient. If a brochure is given, it should include the above notes. You should also note in your patient records that the fact sheet/brochure was given and the specific risks listed were discussed.
Informed decision-making’ reflects that the aim is for the patient to make the right decision about healthcare (or for the decision-maker acting on their behalf to do so), considering all circumstances of their life. It is still a successful outcome if a patient receives and understands all information appropriate for them to make a decision, and then decides to decline consent to the healthcare, even if it is considered by the health practitioner to offer the best clinical outcome.
Failure to obtain a patient’s consent to treatment may result in a civil action for negligence. Registration Board disciplinary action may also follow.
Remember your records are your evidence, unfortunately your word against another is generally not effective, many allegations can be years down the track.
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