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, form 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
To address the risk of a complaint or action alleging failure to obtain informed consent, physicians should cultivate a culture of communication that supports patient understanding of the diagnosis.
For consent to treatment to be considered valid, the patient must be given an adequate explanation about the nature of the proposed 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 refusing treatment.
Information and decision-making
Taking the time to explain a diagnosis and the options for treatment can be challenging in today's hectic healthcare environment. However, physicians have an obligation to provide patients with information that allows them to assess treatment choices and make informed decisions. Patients can arrive at a sound decision about their care, and in turn provide informed consent, by understanding the implications of available treatment options.
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 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 patient’s views, life, 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, and often leads to better health outcomes for patients.
Helping patient decision-making
Physicians may consider the following approaches 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 their level of health literacy.
- Ask the patient if they would like a family member, friend, or other healthcare provider to participate in the discussion.
- Explore with the patient the level of risk they consider 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 using 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. 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. Patients should be encouraged to ask their physician questions about information obtained through these aids.
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. Physicians should also clearly document informed consent discussions in patients’ records.
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 patients.
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.
Reference
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Howe, Edmund G. Beyond Shared Decision Making. J Clin Ethics. 2020 Winter;31(4):293-302.
