Informed Consent (1).pptjhkkijkkkhhghjjkk

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Health & Medicine

Current Legal and Ethical
Controversies in American
Health Care
Informed Consent and Shared
Decision Making

FSU COLLEGE OF MEDICINE
Instructors
Marshall B. Kapp, J.D. M.P.H.
Gregory Todd, J.D., M.D.
– Associate Professor, College of Medicine
– Program Director, FSU Internal
Medicine Residency Program

FSU COLLEGE OF MEDICINE
Why Informed Consent and
Shared Decision Making?
Autonomy/Self-Determination
Beneficence

FSU COLLEGE OF MEDICINE
Elements of Informed Consent
Voluntary
Competent decision maker
Informed

FSU COLLEGE OF MEDICINE
What Information Do You
Want?
 Nature of the problem
 Recommended plan
 Prognosis, with or without intervention
 Reasonable alternatives (always including
doing nothing)
 Risks of recommended plan and
alternatives
 Patient’s responsibilities and limitations
 Financial considerations?
 Other?

FSU COLLEGE OF MEDICINE
Consent Forms
Purpose/Effect
– Document that the process of
communication took place
– Protect the health care provider
Does not take the place of proper
communication.
Does create a presumption that proper
communication took place, shifts burden to
patient to prove that communication
process was inadequate.

FSU COLLEGE OF MEDICINE
Case Discussions
Mr. B, 75-year old man in generally
good health
– Should physician recommend PSA
screening? Should the patient
consent?


FSU COLLEGE OF MEDICINE
Ms. A, 45-year old woman in good
health, no family history of breast
cancer
– Should physician recommend a
screening mammography? Should the
patient consent?

FSU COLLEGE OF MEDICINE
Ms. C is a 60-year-old, post-
menopausal woman with no serious
health problems and no significant
family history of cardiovascular
problems.
– Should her physician recommend
hormone replacement therapy?
– Should Ms. C consent?

FSU COLLEGE OF MEDICINE
Shared Decision Making
 https://www.youtube.com/watch?v=XPm5iEDEI
8Y&list=PL92C4D5A6B4CD339E
 https://www.youtube.com/watch?v=5kXso8aPV
aw&list=PLB7F6CFCD9AFD5F47&index=14
 https://www.youtube.com/watch?v=6pUeUIwQ6
so&index=13&list=PLB7F6CFCD9AFD5F47

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Copyright 2014 American Medical Association. All rights reserved. The Connection Between Evidence-Based Medicine and Shared Decision Making Evidence-based medicine (EBM) and shared decision making (SDM) are both essential to quality health care, yet the interdependence between these 2 approaches is not generally appreciated. Evidence-based medicine should begin and end with the patient: after finding and appraising the evidence and integrating its infer- ences with their expertise, clinicians attempt a decision that reflects their patient’s values and circumstances. Incorporating patient values, preferences, and circumstances is probably the most difficult and poorly mapped step—yet it receives the least attention.1 This has led to a common criticism that EBM ignore s patients’ values and preferences—explicitly not its intention.2 Shared decision making is the process of clinician and patient jointly participating in a health decision after discussing the options, the benefits and harms, and considering the patient’s values, preferences, and circumstances. It is the intersection of patient-centered communication skills and EBM, in the pinnacle of good patient care (Figure). One Without the Other? These approaches, for the most part, have evolved in parallel, yet neither can achieve its aim without the other. Without SDM, authentic EBM cannot occur.3 It is a mechanism by which evidence can be explicitly brought into the consultation and discussed with the patient. Even if clinicians attempt to incorporate patient preferences into decisions, they sometimes erroneously guess them. However, it is through evidence-informed deliberations that patients construct informed preferences. For patients who have to implement the decision and live with the consequences, it may be more per- tinent to realize that it is through this process that patients incorporate the evidence and expertise of the clinician, along with their values and preferences, into their decision-making. Without SDM, EBM can turn into evidence tyranny. Without SDM, evidence may poorly translate into practice and improved outcomes. Likewise, without attention to the principles of EBM, SDM becomes limited because a number of its steps are inextricably linked to the evidence. For example, discus- sions with patients about the natural history of the con- dition, the possible options, the benefits and harms of each, and a quantification of these must be informed by the best available research evidence. If SDM does not incorporate this body of evidence, the preferences that patients express may not be based on reliable estimates of the risks and benefits of the options, and the result- ing decisions not truly informed. Why Is There a Disconnect? A contributor to the existing disconnect between EBM and SDM may be that leaders, researchers, and teach- ers of EBM, and those of SDM, originated from, and his- torically tended to practice, research, publish, and col- labo.

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