Patients' predilections regarding informed consent for hospital treatments

Abstract

BACKGROUND Respect for patient autonomy is a core principle of American medicine. Informed consent is required for surgical procedures and blood transfusions but not for most medical treatments of hospitalized patients. HYPOTHESIS If given the option, patients want to give permission for common medical therapies during hospitalization. SUBJECTS Participants in the study were patients admitted to the medical service of a 350‐bed community teaching hospital. METHODS A questionnaire comprising 4 scenarios of varying risk/benefit ratios was administered to all patients who agreed to participate. RESULTS A total of 634 patients were admitted to the medicine service between June and August 2006. Two hundred and ten patients (103 men, 107 women), with a mean age (± SE) of 63.3 ± 1.1 years, agreed to answer the questionnaire. Of these patients, 85% wished to participate in even trivial medical decision making (ie, potassium supplementation), 92% wished to participate in treatments with moderate risk (ie, diuretic for congestive heart failure). When a risk was initially posed as less than a 5% risk of brain hemorrhage and benefits of therapy were substantially higher (eg, thrombolysis for pulmonary embolus), 93% wanted to make the decision. If the risk of brain hemorrhage was 20% or greater, 95% wanted to make the decision. Younger patients (<65 years) were more likely to prefer requiring doctors to obtain their “permission no matter what” than were older patients (≥65 years), and older patients were more likely to waive consent across levels of risk. CONCLUSIONS Most acutely ill hospitalized medicine patients wished to participate in even the most mundane aspects of their medical decision making. Although it is not logistically feasible to obtain informed consent for every treatment of every hospitalized patient, clinicians should be aware of patients' predilections and might consider offering opportunities for patients to participate in clinical decision making, especially for therapies that carry substantial risk. Journal of Hospital Medicine 2008;3:6–11. © 2008 Society of Hospital Medicine.

Hospitalized Patients' Understanding of Their Plan of Care

“…Research shows that, given the opportunity, most hospitalized patients wish to participate in routine aspects of medical decision making. 22 An important implication of our findings relates to informed consent. Although often considered pertinent only to invasive procedures, the principles of medical informed consent apply to any treatment that carries risk, including the prescription of medications with serious potential adverse effects, as well as the initiation of diagnostic evaluations that may lead to additional testing and/or invasive procedures.…”

The effect of tablet computers with a mobile patient portal application on hospitalized patients’ knowledge and activation

“…Research shows that hospitalized patients have ample time 2 and motivation to engage in health education. 40 Providing hospitalized patients with concurrent access to selected chart content and to electronic educational materials is consistent with Meaningful Use objectives for hospitals and providers. 41,42 Existing Stage 2 requirements for hospitals allow for delays in online chart content access for up to 36 hours following discharge.…”

Variability in Informed Consent Practices for Non-Emergent Procedures in Pediatric Emergency Departments

“…[6][7][8][9] Whether physicians provide the desired information in a manner that is helpful or understandable to patients is also unclear. 10,11 Physicians may use various processes ranging from a simple discussion to a formal written consent document. This may even include "blanket" consent-totreat forms that are presented at the time of arrival to cover consent for an entire hospital encounter.…”