The surgical care practitioner seeking consent: An appropriate delegate?

2018 ◽  
Vol 28 (10) ◽  
pp. 273-277
Author(s):  
Michael Nicholas
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Care Pathway ◽  
Surgical Care ◽  
Recent Case ◽  
Health Board ◽  
Shared Decision ◽  
Surgical Team ◽  
Surgical Practice

Surgical care practitioners (SCPs) have become recognised as integral members of the surgical team in many healthcare establishments. Seeking informed consent either as the operating practitioner or on behalf of the surgeon, as their delegate, has becoming routine for many SCPs. Informed consent is a critical step in the patient’s care pathway and fundamental in fostering shared decision making and safer surgical practice. The relatively recent case of Montgomery v Lanarkshire Health Board has highlighted a need for those practitioners seeking informed consent to critically examine their practice and revisit the founding principles of the process.

scholarly journals Shared Decision Making for Surgical Care in the Era of COVID-19

2020 ◽  
pp. 019459982095413
Author(s):  
David Forner ◽  
Christopher W. Noel ◽  
Ryan Densmore ◽  
David P. Goldstein ◽  
Martin Corsten ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Surgical Care ◽  
Health Care Use ◽  
System Capacity ◽  
Shared Decision ◽  
Surgical Practice ◽  
Global Pandemic ◽  
Scientific Expertise ◽  
Patient Values

The global pandemic caused by severe acute respiratory syndrome coronavirus 2 has upended surgical practice. In an effort to preserve resources, mitigate risk, and maintain health system capacity, nonurgent surgeries have been deferred in many jurisdictions, with urgent procedures facing increasing wait times and unpredictability given potential future surges. Shared decision making, a process that integrates patient values and preferences with the scientific expertise of clinicians, may be of particular benefit during these unprecedented times. Aligning patient choices with their values, reducing unnecessary health care use, and promoting consistency between providers are now more critical than ever before. We review important aspects of shared decision making and provide guidance for its perioperative application during the coronavirus disease 2019 pandemic.

Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law

2017 ◽  
Vol 45 (1) ◽  
pp. 12-40 ◽  
Author(s):  
Thaddeus Mason Pope
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Legal Doctrine ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Decision Making Processes

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

Das präoperative anästhesiologische Patientengespräch

2009 ◽  
Vol 66 (7) ◽  
pp. 503-508 ◽  
Author(s):  
Christoph Harms ◽  
Christoph H. Kindler
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision

Anästhesisten treffen ihre Patienten häufig in Ausnahmesituationen an, geprägt von Angst und großer Unsicherheit. Selbst zeitlich kurze Kontakte sind daher meist intensiv und bedeutsam. Das persönliche, anästhesiologische Gespräch steht am Beginn der Beziehung von Patient und Anästhesist und soll die geplanten Maßnahmen, welche der Anästhesist durchführen wird, erklären und begleiten. Ein solches Gespräch dauert heute durchschnittlich 20 Minuten. Es beinhaltet die Erhebung der Anamnese, die strukturierte und verständliche Informationsübermittlung zwischen Anästhesist und Patient (inklusive Informationen über die anästhesiologischen Interventionen, Instruktionen zum Verhalten des Patienten und die offene und klare Kommunikation von Vor- und Nachteilen sowie Risiken möglicher Anästhesieverfahren) sowie den professionellen Umgang mit den Emotionen des Patienten, insbesondere seiner präoperativen Angst. Da Patienten heute in der Anästhesiologie vermehrt in den Entscheidungsprozess mit einbezogen werden, entwickelt sich dieses Gespräch zunehmend von einer eher paternalistischen Arzt-Patienten Interaktion zu einer gemeinsamen Entscheidungsfindung, dem so genannten „shared decision making“. Formal sollte das präoperative Gespräch die bekannten Voraussetzungen für eine erfolgreiche Verständigung zwischen Patient und Arzt wie Deutlichkeit, Eindeutigkeit, identische Kodierung, Empathie und Rückmeldung erfüllen und mit dem einholen eines „informed consent“ enden.

scholarly journals Principles for screening: Too few concerns for informed consent and shared decision-making?

2018 ◽  
Vol 190 (37) ◽  
pp. E1115-E1115 ◽  
Author(s):  
Alain Braillon ◽  
Philippe Nicot ◽  
Cécile Bour
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision

Can the current hypodontia care pathway promote shared decision-making?

2019 ◽  
Vol 46 (2) ◽  
pp. 126-136 ◽  
Author(s):  
Sophy Barber ◽  
Sue Pavitt ◽  
David Meads ◽  
Balvinder Khambay ◽  
Hilary Bekker
Keyword(s):  
Decision Making ◽  
Young People ◽  
Shared Decision Making ◽  
Information Exchange ◽  
Care Pathway ◽  
Information Provision ◽  
Alternative Methods ◽  
Teaching Hospitals ◽  
Shared Decision ◽  
Cross Sectional

Objective: To determine the extent to which the current care pathway in hypodontia promotes shared decision-making (SDM). Design: Exploratory cross-sectional study using qualitative methods. Setting: Orthodontic department of two NHS teaching hospitals in Yorkshire. Participants: Young people aged 12–16 years with hypodontia of any severity and at any stage of treatment, and their parents and guardians. Methods: (1) Observation and audio-recording of interdisciplinary consultation in hypodontia clinics (n = 5) without any researcher interference; (2) short, structured interviews with young people with hypodontia (n = 8) and their parent (n = 8) using a topic guide to explore themes around decision-making. Audio-recordings were transcribed and analysed using a thematic framework. Results: Consultations were used as an opportunity for interdisciplinary discussion, information provision and treatment planning. Evidence of good communication was observed but patient engagement was low. The decision to be made was usually stated and treatment options discussed, but time constraints limited the scope for adequate information exchange and assessment of understanding. No methods were used to establish patient and family preferences or values. Interviews suggested parents expect the dental team to make decisions and young people rely on parental advocacy. Despite little evidence of SDM, participants reported satisfaction with their treatment. Conclusions: The current care pathway for hypodontia does not support clinicians in the steps of SDM. Recommendations for improving SDM processes include support to identify preference-based decisions, greater access to comprehensive and accessible patient information to enable preparation for consultation, alternative methods for effective communication of complex information and use of preference elicitation tools to aid value-driven decision-making.

scholarly journals Perioperative shared decision-making in the Bay of Plenty, New Zealand: Audit results from a complex decision pathway quality improvement initiative using a structured communication tool

2020 ◽  
Vol 48 (6) ◽  
pp. 473-476
Author(s):  
Heidi C Omundsen ◽  
Renee L Franklin ◽  
Vicki L Higson ◽  
Mark S Omundsen ◽  
Jeremy I Rossaak
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Shared Decision Making ◽  
Elective Surgery ◽  
Quality Improvement Initiative ◽  
Health Board ◽  
Shared Decision ◽  
Communication Tool ◽  
Complex Decision ◽  
Structured Communication

Patients presenting for elective surgery in the Bay of Plenty area in New Zealand are increasingly elderly with significant medical comorbidities. For these patients the risk–benefit balance of undergoing surgery can be complex. We recognised the need for a robust shared decision-making pathway within our perioperative medicine service. We describe the setup of a complex decision pathway within our district health board and report on the audit data from our first 49 patients. The complex decision pathway encourages surgeons to identify high-risk patients who will benefit from shared decision-making, manages input from multiple specialists as needed with excellent communication between those specialists, and provides a patient-centred approach to decision-making using a structured communication tool.

Measuring Informed Consent and Shared Decision Making: A Quantitative Analysis

2016 ◽  
Vol 223 (4) ◽  
pp. e16
Author(s):  
Susan C. Pitt ◽  
Angela M. Ingraham ◽  
Megan C. Saucke ◽  
Elizabeth M. Wendt ◽  
Courtney J. Balentine ◽  
...  
Keyword(s):  
Decision Making ◽  
Quantitative Analysis ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision
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