17.3 Informed consent and patient autonomy

Informed consent is a crucial aspect of patient care, ensuring individuals are educated about their medical options and can make voluntary decisions. It respects patient autonomy, promotes trust, and prevents unethical practices. Valid consent requires clear disclosure, patient comprehension, and voluntary decision-making.

Patient autonomy and decision-making involve assessing capacity and using strategies for shared decision-making. This includes evaluating understanding, considering factors affecting capacity, and employing techniques like plain language, active listening, and visual aids to involve patients in their care decisions.

Informed Consent

Importance of informed consent

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• Educates patients about potential benefits, risks, and alternatives of proposed medical interventions enabling voluntary and informed decisions about their care
• Respects patients' right to self-determination and control over their own body and healthcare decisions
• Ensures patients are actively involved in their care considering their values, beliefs, and preferences
• Promotes trust and open communication between patients and healthcare providers
• Helps prevent unethical or coercive medical practices (forced treatment, withholding information)

Elements of valid consent

• Disclosure of information covering nature and purpose of proposed intervention, potential benefits and risks, alternatives including no treatment option, and probable consequences of declining intervention
• Patient comprehension of information provided in a manner considering language, health literacy, and cognitive abilities encouraging questions and clarifying misunderstandings
• Voluntary decision-making by the patient without coercion, undue influence, or pressure from others with adequate time to consider information and decide
• Documentation in the patient's medical record including information provided, patient's understanding, and their decision

Patient Autonomy and Decision-Making

Assessment of decision-making capacity

• Evaluates patient's ability to understand relevant information, appreciate consequences of their decision, and communicate a consistent choice
• Factors affecting decision-making capacity include cognitive impairments (dementia, delirium, intellectual disabilities), mental health conditions (severe depression, psychosis), and temporary impairments (medication side effects, pain, acute illness)
• Situations requiring surrogate decision-makers when patient lacks capacity, has designated a surrogate through advance directive or power of attorney, or court appoints a guardian
• Hierarchy of surrogate decision-makers: patient-designated surrogate, legal guardian or individual with power of attorney, spouse or domestic partner, adult children, parents, adult siblings

Strategies for shared decision-making

1. Establish respectful and trusting relationship with patient and family
2. Use plain language avoiding medical jargon when explaining information
3. Employ active listening skills encouraging patients and families to express concerns, values, and preferences
4. Use visual aids (diagrams, videos) to enhance understanding of complex medical information
5. Involve patients and families in decision-making process presenting options and discussing potential benefits and risks of each
6. Respect cultural, religious, and personal beliefs that may influence decision-making
7. Allow adequate time for patients and families to process information, ask questions, and make decisions
8. Regularly assess patient's and family's understanding addressing any knowledge gaps
9. Collaborate with other healthcare professionals (social workers, chaplains) to provide additional support and resources as needed
10. Document shared decision-making process in patient's medical record including information discussed, patient's and family's preferences, and agreed-upon plan of care