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Consent (Making decisions (Information sharing (Principles (Tailored to…
Consent
Making decisions
Information
sharing
Principles
Tailored to patient need, priorities and current understanding
Never assume what they want to know
Never assume their current level of understanding
Inform them on diagnosis, prognosis, investigations, treatment options, benefits and risks, HCPs involved, ongoing research trials, right to a second opinion
Check understanding and invite questions
Provide additional information resources
Respect decisions, explain your views and concerns
Answering
questions
Honest
As fully as needed by patient
Witholding
information
Patient request
If patient with capacity doesn't want to know, investigate why
but ultimately respect their decision; they will still need to consent
to investigations and treatment in the same way
Always record reasons for withholding info
Family/carer request
Only if it would cause patient serious harm
(seriously upset/refuse treatment)
Always record reasons for withholding info
Sharing
information
In a way the patient can understand
Appropriate time and place
Involve other HCPs
Patient time to reflect and ask questions
Provide other resources if needed
Involve family if patient wishes
Responsibility for consent
Suitably trained and qualified
Knowledge of the condition and proposed
investigations and treatment
Acts in accordance with GMC
Discussing
SEs and risks
Clear information in a way the patient can understand
SEs (frequent or serious), complications, treatment failure
Patient views on what is most important to them
Check understanding
Discuss any future events that may occur when
the patient may not be in a position to make decisions
Expression
of consent
Orally, in writing, implied
Oral/implied usually sufficient for
standard investigations or treatment,
or in emergency situations
High risk needs written consent
e.g. surgery, significant
consequences for patient,
complex treatment, research
Some other treatments require
written consent by law e.g. fertility tx
Record consent in notes
Reviewing
decisions
Check just before investigation/procedure
Time passed since initial decision
Changes in patient condition or aspects
of the investigation/treatment
New information available e.g. SEs
Children and
young people
Involve as much as possible
Person <16 may have capacity (assess)
Person >16 assumed to have capacity
Advance care
planning
Appropriate patient
Condition affecting
quality or length of life
Condition that will
progressively impair
capacity (e.g. dementia)
Other loss/impairment of
capacity is possible
(e.g. mental health disorder)
Discussion
Patient wishes, preferences, fears
Feelings, beliefs and values
Procedures or treatments they
would not want to recieve
Significant others to be involved
Emergency measures e.g. CPR
Provide advice on formalising wishes
Recording
Record all discussions
with patient
Capacity issues
Legal aspects
Criteria and procedures for
making decisions for adults
lacking capacity
Mental Capacity Act 2005 (England and Wales)
Adults with Incapacity Act 2000 (Scotland)
Presumption
of capacity
Assume capacity
until proven otherwise
Do not assume lack of capacity due to
disability, age, mental illness, or making
a decision that you disagree with
Maximising ability
to make decisions
Simple vs complex decisions,
fluctuating capacity
Discuss at place and time
most suitable for patient
Ask if anything will help
them to understand/remember
information that you provide
(next of kin present, written info)
Best communication method
Review decisions regularly
Assessing
capacity
Components
Understands infromation
Retains information
Weighs up information
to make a decision
Communicates their decision
Uncertainty
Other HCPs e.g. nurse
involved with care
Next of kin
Specialists e.g. psychiatrists,
geriatricians, neurologist, SALT
Legal advice
Other factors
to consider
Lack of capacity is
permenant or temporary
Treatment would benefit
Views of next of kin,
legal representatives
Patient's known wishes
Resolving
disagreements
Independent advocate
Discussion with colleagues
Mediation services
Legal advice
Emergency situations
Treat without consent provided
it is immediately necessary to
save life/prevent deterioration
Choose least restrictive option
for future choices
If regain capacity, inform them
straight away and allow to
make all further decisions
Principles
Applicability
All investigations and treatment
Dr-patient partnership
Open, trustful, good communication
Listen to the patient
Discuss diagnosis, investigations, treatment, prognosis
Share information to a depth guided by the patient
Maximise ability for patient to make own decision
Respect patient's decisions
Capacity model
Patient has
capacity
Dr and patient assess current condition
Dr advises on suitable investigations and treatments
(including risks, benefits and option of no treatment)
Patient weighs up information to make a decision
If patient asks for a treatment the doctor considers of no benefit, discuss with the patient but doctor under no obligation to provide
Patient does not
have capacity
Work with other HCPs and family to
make a decision in best interests
Take into account any known patient preferences