How can I help ensure that my patients understand the information I give them and that their consent is informed and valid?
For patient consent to be valid it must be informed; this can only be achieved if patients understand the nature of the proposed treatment, including any associated risk and benefit information (where available), and alternative treatment options, and the rationale for the suggested treatment. The patient needs to be competent to make decisions, and to understand the information given to them, whatever their age, disabilities, and cultural background.
It is important to
- Ensure you develop a trusting relationship as this is needed to communicate information effectively.
- Discuss risk in a context that conveys competence and caring, and engenders trust.
- Communicate facts in numbers and words.
- Compare risks of osteopathic treatment to risks associated with alternative treatments for their condition, and the risk of daily activities, such as travel.
- Compare the risks of osteopathic treatment with the risk of doing nothing.
- Avoid comparing risk of treatment with the risk of natural disasters as patients have no control over these events, nor is it fair to compare risk with things that they enjoy doing, for example sport.
- Avoid the use of relative risk, such as A is 3 times more risky than B.
- Remember that although a leaflet is helpful it is not sufficient on its own. Information needs to be explained and personalised. Present a range of information in different formats to suit different people.
- Present statistics to patients in context with the patient’s individual presentation and profile.
- Use visual aids with non-threatening colours, symbols and wording.
- Be honest about what we know and do not know – convey uncertainty.
- Explore patients’ understanding, reactions and opinions about the information.
It is important to
- Have a discussion about treatment choices when your patient is comfortable so that they can have eye contact with you.
- Ensure your patient does not feel vulnerable; this may mean covering them with a gown, allowing them to re-dress, or allowing them to sit up and speak to you at eye-level. Check your patient’s preference.
- Ensure that consent is received voluntarily from patients without them feeling under pressure to make their decision.
- Remember that consent is an on-going process during a treatment session, and at subsequent visits; it is not a one-off event.
- The emphasis for consent has shifted from solely disclosing information to sharing information with the patient.
- Partnership and shared decision-making (SDM) are now foremost in the consent process.
- Ethically, patients have a right to understand and determine what happens to them – their illness, their prognosis and their treatment options, even if they do not wish to determine their treatment decisions.
Daniels and Vogel, 2012, conducted a survey of patients’ preferences for information and the process for consent in osteopathy8. There was a range of opinion regarding confirmation of consent on follow up treatments; some patients believed it to be unimportant, and others believed it to be of some importance. Of those that thought it was important, half of them thought this should be obtained at the start of the consultation and most of them preferred it to be confirmed verbally.
It is important to ask patients about their personal preferences for the ongoing consent process and it may also be helpful to document these preferences in your patient notes.
8. Daniels G, Vogel S. Consent in osteopathy: A cross sectional survey of patients’ information and process preferences. International Journal of Osteopathic Medicine. 2012;15:92-102