No one in the healthcare arena can escape the legal and regulatory pitfalls we encounter today while trying to provide care to our patients. Ensuring they understand the care being provided is more essential now than ever. Not only does it protect healthcare professionals and healthcare organizations, but – primarily and most importantly – it protects the patient.
As we all know, this is paramount.
Informed Consent: The Textbook Definitions
The definition of informed consent can vary.
Black’s Law Dictionary (Eighth Edition) defines it as the following:
1) A person’s agreement to allow something to happen, made with full knowledge of the risks involved and the alternatives.
2) A patient’s knowing choice about a medical treatment or procedure, made after a physician or healthcare provider discloses whatever information a reasonably prudent provider in the medical community would give to a patient regarding the risks involved in the proposed treatment or procedure.
Joint Commission defines informed consent as:
“Agreement or permission accompanied by full notice about the care, treatment, or services that is the subject of the consent. A patient must be apprised of the nature, risks, and alternatives of a medical procedure or treatment before the physician or other healthcare professional begins any such course. After receiving this information, the patient then either consents to or refuses such a procedure or treatment.”
What really is informed consent?
For simplicity’s sake, informed consent essentially means that a medical provider must explain a situation in a way the patient (or patient’s medical DPOA, proxy, or caregiver) can understand of all the risks, benefits, and alternative options associated with the care being provided.
The principle is simple. A provider or healthcare professional has duty to disclose information to a patient that is intended to allow the patient to make an educated and “informed” decision regarding their treatment. And – just as importantly – their refusal of such treatment.
A misconception commonly associated with obtaining informed consent is that simply obtaining the signature of the patient means you have obtained their consent. That is not always true. Informed consent is much broader than just obtaining a signature. We, as professionals, must ensure we are effectively communicating with the patient at all times in terms they, or a proxy, can understand.
Avoid using even common medical terms. By making the assumption that a patient understands medical terminology can result in a failure of informed consent. A great way to ensure a patient understands what you are saying is to have the them repeat back their understanding of the treatment or procedure. Don’t assume that by simply receiving a “yes” to the question “do you understand?” confirms the patient truly understands.
Education may play a role, but this is not the only barrier in obtaining true informed consent. Many other things will contribute to the lack of understanding. Emotional stress, commonly seen when someone is facing a medical treatment, can compound the lack of comprehension and must be considered.
Another factor contributing to a lack of informed consent can be a healthcare professional’s lack of understanding of a patient’s culture, religion, or ethnicity. For example, in groups such as Asian, Native American, and Eastern Indians, a father or husband must be consulted because they view the patriarch as the primary decision maker.
In addition, unintentionally withholding information from the patient can be a pitfall when attempting to obtain true informed consent. Truthful, factual, and honest communication between a healthcare provider and patient is critical at all times.
Hospice Informed Consent
In all healthcare settings, informed consent is required. Hospice and palliative care is no different.
In fact, in end-of-life care, the need for informed consent is crucial. By determining what, if any, treatment a patient would like to pursue to ensure self-determined life closure is critical in honoring both a patient's wants and needs.
This may be as simple as discontinuing the last few radiation treatments to elect hospice. It may be discussing if now is the time to consider a “Do Not Resuscitate” order. Maybe the patient is declining and not eating well. Providing the patient and family with information on the benefits and adverse effects of enteral feedings and the risks of surgical intervention will allow the patient and family to consider which is the best option for them. This will ensure that they are able to give “informed consent” no matter what.
As healthcare professionals, we must not only strive to, but ensure that we have obtained true, informed consent from our patients. If we are not transparent, clear, and concise when discussing treatment options, risks, and alternatives, we have profoundly failed our patients.
For more information on hospice informed consent read our hospice faq and contact Crossroads Hospice and Palliative Care at 1-888-564-3405.
DeAnna Looper RN, CHPN, CHPCA, LNC
Senior Vice President of Clinical Operations
Crossroads Hospice & Palliative Care
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