Originally published April 2014
Physicians play a major role in helping patients understand both diagnosis and the available treatment options. The information provided to patients by physicians, and the ensuing dialogue, forms an essential part of the informed consent discussion.
Helping patients understand the implications of the care plan and engaging them in the decision-making process strengthens the exchange and partnership between physicians and patients. It can also promote a patient's adherence to the treatment plan.
Consent and medico-legal concerns
An analysis of medico-legal cases highlights the frequency in which informed consent is a contributing factor. Between 2008 and 2013, 21% of all CMPA legal cases included an issue related to informed consent.
To address this, physicians should cultivate a culture of communication that supports patient understanding and comprehension of both the diagnosis and available treatment options.
For consent to treatment to be considered valid, the patient must be given an adequate explanation about the nature of treatment and the anticipated outcome, as well as significant risks involved and alternatives available. Patients should also be made aware of the potential outcome of no treatment.
Information and decision-making
Taking the time to explain a diagnosis and the options for treatment is challenging in today's hectic healthcare environment. However, physicians have an obligation to provide patients with information that allows them to assess choices. Patients can arrive at a sound decision about their care, and in turn provide informed consent, by understanding the implications of different treatments.
By encouraging a constructive dialogue with patients, physicians can foster an environment that supports effective decision-making, which is central to patient-centred care. In this way, patients become empowered to actively manage their health condition and the associated care plan. This often leads to better health outcomes for patients. This approach to communication, also known as "shared decision-making," treats the patient as an expert in their own life and circumstances.1 It fosters the development of plans which reflect an understanding of the patients' views, life, and cultural experiences, and healthcare goals. In this model of communication, clinical information is exchanged rather than unilaterally imposed. This encourages a meaningful discussion of the patient's condition, treatment options, outcomes, and uncertainties.
As most patients appreciate openness, and the opportunity to work through the options available to them, an approach which encourages patient understanding and adherence to treatment plans is valued.
Helping patient decision-making
Physicians may consider the following approaches to help patients gain a suitable level of knowledge and to support effective decision-making.
- Establish how the patient prefers to receive information (e.g. format, level of information, validation of existing knowledge, etc.).
- Consider the patient's cultural values and beliefs, and the level of health literacy.
- Ask the patient if a family member, friend, or other healthcare provider should participate in the information exchange.
- Adapt the information exchange to the circumstances and severity of the diagnosis (e.g. could the information cause the patient undue distress?)
- Explore with the patient the level of risk considered acceptable?
- Listen and respond to the patient's ideas, concerns, and expectations about their health.
- Present or direct the patient to credible sources of information about their condition (e.g. hospital library, web resources, pamphlets).
- Consider use of decision aids that may help the patient better understand and weigh the options.
- Consider a phased approach, granting the patient an opportunity to absorb the information before a decision is required.
Selecting information — Quality over quantity
With the explosion of online resources, it has never been easier for patients to find health information. However, not all sources of medical information should be considered equal. While encouraging patients to participate in their own care, physicians will also need to promote accurate and reliable sources of health-related information. If patients present with incomplete or inaccurate information, it is important for doctors to review the facts, address misinformation, and answer questions.
A physician may provide the patient with a printed handout on their condition or direct a patient to one of the increasingly popular evidence-based online health decision aids available to clinicians and patients alike. Such aids allow patients to consider information on their own, away from the doctor's office. There are some well-recognized, sophisticated, online databases for decision aids, the best of which meet internationally agreed upon criteria. The International Patient Decision Aid Standards (IPDAS) Collaboration highlights credible sources of information and includes a checklist for judging the quality of patient decision aids.2 While these tools can assist patients to make appropriate decisions, they should be seen only as an adjunct and not a substitute to consent discussions.
Patient decision aids provide information to improve the quality of decisions, particularly when those decisions are complex and require evaluating multiple treatment options. The goal is to provide information that can support patients in making decisions that are in keeping with their values and circumstances. Rather than over-loading the patient with too much information, the best aids are specific and help to streamline medical options.
Informed consent — Rooted in meaningful information and discussion
Patients benefit from receiving information on their diagnosis and treatment options, and from participating in a meaningful discussion about the care plan. Despite significant constraints, physicians will want to allocate the time necessary to help patients obtain and clarify information about their health conditions.
The exchange of information can take different forms, and be aided by various tools and resources. In all circumstances, the goal is to promote a patient's understanding and decision-making.
Patients have the right to make decisions about their own health and to ask questions about their treatment options. Physicians are ideally positioned to help patients navigate the abundance of information that confronts today's patient population.
While some patients will choose to be actively involved in treatment decisions, others may rely entirely on the recommendations presented by their physician. Regardless of how engaged patients are in weighing options, physicians have a duty to work with patients to achieve informed consent.
- Godolphin, William, "Shared Decision-Making," Healthcare Quarterly, August 2009. Accessed March 2014 from: www.longwoods.com/content/20947
- International Patient Decision Aid Standards (IDPAS) Collaboration website. Accessed March 2014 from: http://ipdas.ohri.ca/what.html