RemindersTurn off all pagers, cell phones, and computers during this

educational session.

You are required to participate in the group debriefing session when you have completed the Standardized Patient (SP) encounter.

Please complete the “Pre-Program Self Assessment: Confidence Level” form

Effective Patient Communication

Module development supported by a grant from the Picker Institute / Gold Foundation 2010 Challenge Grant

Informed Consent

Learning ObjectivesDescribe the basic principles of shared decision-

makingDemonstrate key elements of the informed consent

conversation Identify some potential challenges in the informed

consent conversation

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Expected OutcomeObtain informed consent consistent with professional

standards and shared decision-making principles

Informed Consent Conversation

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What did you think?

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Provide privacyIntroduce selfDetermine who else should be presentEnsure no interruptionsProvide comfortable spaceCreate welcoming environment.

Setting the Environment

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Shared Decision-making Overview

Identify that problem requires a shared decision-making process.

Assess the patient’s information preferences and level of involvement in decision-making.

Discuss management options and patient’s wishes.

Confirm patient’s understanding and choice.

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D-H Informed Consent Policy Overview Remember to perform hand hygieneConversation

Introduce yourself & explain why you are thereVerify patient’s identity Use plain language & avoid medical jargonDiscuss:

nature & purpose of procedure risks, expected benefits possible alternatives, right to refuse treatment & possible consequences of refusal

Check for understanding

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D-H Informed Consent Policy OverviewDocumentation includes both:

Consent Form: Provider’s signature signifies that the conversation took place Patient’s signature indicates consent & questions were solicited & answered Must be dated & timed

Valid for 90 days Recurring procedures-valid for one year

Note in record: Summary of the conversation

Risks & benefits Alternatives Special circumstances or concerns

Patient decision regarding procedure / intervention

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ChallengesWhat are some challenges you have seen in

obtaining informed consent?

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Common Challenges: Incapacitated or Incompetent Patient

Is there an Advance Directive? If not, who is legal next of kin?Is there time to go through guardianship process? Is the procedure urgent?

Care Management can help!ALWAYS do what is in best interest of the patient!

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Common Challenges: Treatment Refusal

Competent patients have right to refuse interventions

Confirm patient’s capacity to understandGet help from another physicianConsider psychiatry consultConsider ethics committee consult

Medical staff provides medical informationInvolve Care Management as needed

Financial assistance

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Common Challenges: Language BarrierUse an Interpreter unless patient refuses

Interpreter Coordinator may be reached at ext. 5-5792 during daytime hours (8am-5pm)

Call on-call Care Management staff during nights and weekends

If patient refuses an interpreter, a family member may be usedPhysician may request interpreter if uncomfortable

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Consents for MinorsParents must legally consent for their children under 18

years of ageImportant to have assent from the adolescent patient

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Partnering with Patients to Improve SafetyHand hygieneTwo patient identifiers

InpatientOutpatient

VerifyProcedureSite

Time out

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What’s Next?

ExpectationsReminders

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(Mahmud, 2008)

References1. Pellerin M, Elwyn G, Rousseau M, Stacey D, Robitaille H, Legare F. Toward Shared Decision Making: Using

the OPTION Scale to Analyze Resident-Patient Consultations in Family Medicine. Acad Med. 2011;86(8):1010-1018.

2. Weiss BD. Removing Barriers to Better, Safer Care, Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians. 2nd ed. American Medical Association Foundation and American Medical Association. 2007; http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf. Accessed December 15, 2009.

3. Dartmouth Hitchcock Medical Center (DHMC). Informed Consent (Policy No. OCA.0007). DHMC Clinical Operations Policy Library. 2011; http://policy.hitchcock.org/PolicyStore/193/193_83639.pdf. Accessed November 18, 2011.

4. Henry Ford Health System Department of Medical Education. Informed Consent. [DVD]. Detroit, MI: Henry Ford Health System; 2009.

5. Henry Ford Health System Department of Medical Education. Sharing Bad News. [DVD]. Detroit, MI: Henry Ford Health System; 2009.

6. Mahmud A. File: Serious Discussion image by Ashfaq.JPG. Dhaka University Institute of Fine Arts; 2008. Wikimedia Commons. http://commons.wikimedia.org/wiki/File:Serious_Discussion_image_by_Ashfaq.JPG. Accessed December 6, 2010.

7. Wind LA, Van Dalen J, Muijtjens AMM, Rethans JJ. Assessing Simulated Patients in an Educational Setting: The MaSP (Maastricht Assessment of Simulated Patients). Medical Education, 39-44; 2004.

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