Consent or inform? or both
We often see consent as the unfunny brother-in-law who monopolizes conversations without saying anything interesting. In other words, we often see Informed Consent as something that adds no value to the process and only takes time away from us.
Let’s start this Note with a truism: “Informed consent is here to stay.” This does not exclude that, frequently, we continue to see him as the not-so-funny brother-in-law who monopolizes the conversation at family meals and does not say anything interesting or, said from a care point of view, we frequently see Informed Consent as something that does not contribute value to the process and only manages to take away our time. This vision is the one that emphasizes the concept of “consent” and its legal derivatives, leaving aside the aspect that emphasizes information to the patient and their participation in the care process.
Perhaps this vision can change if we begin to consider that informed consent is part of the right of every patient to receive adequate information about a medical procedure, in order to freely decide whether or not to accept it. And as a right of patients it is considered in the vast majority of accreditation models. An example: Joint Commission International, in its accreditation model, addresses informed consent within the scope dedicated to patients’ rights and considers that the requirements for considering informed consent adequate are voluntary, information and understanding.
Therefore, a process is established in which the last stage, voluntary consent (or non-consent) is the final consequence of an information process that requires the patient to fully understand the meaning of it.
Even so, it is common for patients to sign their Informed Consent under conditions that are far from optimal. What are the reasons? Let’s venture some, fruit of our experience:
- The use of technical vocabulary not understandable outside the professional environment.
- The lack of time to adequately inform the patients, limiting the concepts that are transmitted and the possibility of asking questions that could help them better understand the procedure.
- The request for consent just before carrying out the procedure, with the patient already prepared for it, and without a rational option to reflect on the benefits of performing the procedure, but, above all, on the risks involved and the alternatives existing (three variables that must be explained without exception).
- The request for informed consent understood as a purely administrative act, carried out by people who have little or nothing to do with the procedure.
Our organizations must guarantee a correct procedure for obtaining Informed Consent. If it is suspected that this is not the case, it should be investigated if these anomalous practices occur in our organization. When this occurs, obtaining informed consent has gone from being a right of the patient to a defense mechanism for the health organization. As we have said, information is subordinated to consent. It is not acceptable and requires corrective measures.
However, we are sure that in recent years the quality of informed consent has been improving. In a 2000 paper, Bottrel et al. found that, of 157 hospitals, only 26% of the consent forms included the “basic elements” of the procedure, risks, benefits, and alternatives. We are sure that, at present, these results are much better, since they made reference to the documentary support. For the quality of the document, two criteria are used: length less than 490 words and a score on the INFLESZ readability scale greater than 55. However, it is advisable to carry out an internal review to be sure that this right of patients is respected. adequately in the quality of verbal information, which is what the patient values most.