Information
Provision of information is key to obtaining valid consent. Unless patients have sufficient information, they are not in a position to decide what is best for them. In Consent: Patients and Doctors Making Decisions Together, the GMC has set out what patients ought to know before deciding whether to consent to treatment or an investigation (see Box 5).
Box 5: Information to be given in the consent process
You must give patients the information they want or need about:
- the diagnosis and prognosis
- any uncertainties about the diagnosis or prognosis, including options for further investigations
- options for treating or managing the condition, including the option not to treat
- the purpose of any proposed investigation or treatment and what it will involve
- the potential benefits, risks and burdens, and the likelihood of success, for each option; this should include information, if available, about whether the benefits or risks are affected by which organisation or doctor is chosen to provide care
- whether a proposed investigation or treatment is part of a research programme or is an innovative treatment designed specifically for their benefit
- the people who will be mainly responsible for and involved in their care, what their roles are, and to what extent students may be involved
- their right to refuse to take part in teaching or research
- their right to seek a second opinion
- any bills they will have to pay
- any conflicts of interest that you, or your organisation, may have
- any treatments that you believe have greater potential benefit for the patient than those you or your organisation can offer.
GMC, Consent: Patients and Doctors Making Decisions Together (June 2008), para 9.
Discussions about the options available to the patient may take place over several consultations. Carried out properly, the process should be more than a one-sided delivery of information – it should include an exploration of the patient’s understanding, knowledge, beliefs, values and concerns, identifying the factors that are significant to them. The information should then be tailored accordingly.
When a patient does not want to hear all (or any of) the relevant details of an investigation or treatment, this should be documented in their medical record
The GMC warns against making assumptions about a patient’s level of understanding or the information they might want or need,6 placing considerable emphasis on being led by the patient’s agenda rather than the doctor’s. This will usually require sensitive questioning as well as respectful listening (see paras 7–10 and 28–31).
Some patients don’t want to know all the details about treatments and their attendant risks and benefits, making it difficult to secure their valid consent. The GMC advises that, in this situations, although the patient’s wishes should be respected as far as possible, the doctors “must still give them the information they need in order to give their consent”.
Regardless of their lack of interest in the details, at a bare minimum they will still need to know why the investigation or treatment is being proposed and what it will entail in terms of pain or discomfort and anything they must do to prepare for it.7 When a patient does not want to hear all (or any of) the relevant details of an investigation or treatment, this should be documented in their medical record.
Patients’ questions should be answered fully and honestly. The only justification for withholding information from a patient is if there are good grounds for believing that it would cause serious physical or mental harm to the patient. Such circumstances are extremely rare, and when they do occur, it is important to document the decision to withhold and the rationale behind it.
If intervention is needed urgently, it may be impossible to provide all the information set out in Box 5 (above); even so, the patient should be given a broad outline of what is being recommended and why, and if the patient asks questions, the doctor’s responsibility is to answer them.