Transcript Informed Consent For Chemotherapy

Informed Consent For
Chemotherapy
Angela Madigan
Lead Chemotherapy Nurse for MCCN
Macmillan Haematology CNS
Contents
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What is informed consent?
Why consent at all?
Law and Ethics
Department of Health
The Role of the CNS
Research
Communication Skills
What is Informed Consent?
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Informed consent is an ongoing agreement by a
person to receive treatment, undergo procedures or
participate in research, after risks, benefits and
alternatives have been adequately explained.
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There is a professional, legal, and moral consensus
about the clinical duty to obtain informed consent.
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It is the method by which fully informed, rational
persons may be involved in choices about their health
care.
Why Consent at all ?
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A reason for taking informed consent
seriously is that it provides assurance that
patients and others are neither deceived nor
coerced.
Since the point of consent procedures is to
limit deception and coercion, they should be
designed to give patients and others control
over the amount of information they receive
and the opportunity to question consent
already given.
Law and Ethics
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Informed consent is bound
by ethical and legal
frameworks
As a matter of law and
medical ethics, senior
cancer professionals are
required to obtain a
patient's informed consent
before administering
chemotherapy
Even if the professional
strongly believes that
chemotherapy is the best
treatment option available
to the patient
The Department of Health
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The NHS Cancer Plan
(2000) emphasised the
importance of good
communication
between patients and
staff caring for them.
This was reinforced by
the DH's (2007) Cancer
Reform Strategy, which
featured staff training in
communication as a
key area.
Department of Health
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The strategy (CRS) says that all senior cancer
professionals will, be expected to demonstrate they
have the necessary competencies in face-to-face
communication after a training course.
This means showing the level of competencies to
communicate complex information, involve patients
in clinical decisions and offer choice.
The DH (2007) says that what is also needed to
ensure that other healthcare staff who treat and
support patients with cancer have access to good
communication skills training.
The Role of the CNS
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Cancer clinical nurse
specialists are vital in
ensuring patients are
given enough
information to make
informed decisions.
Also to give informed
consent to palliative
chemotherapy patients,
and to support them
through this decisionmaking process.
The Role of the CNS
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Nurses can provide vital support to patients in
guiding them through the information and
helping them to make difficult decisions,
ensuring they have sufficient information to
give informed consent.
As a professional nurse you are accountable
for your practice and should always act in the
best interest of your patient.
In Reality
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In my experience,
patients are often so
relieved to be receiving
any treatment that they
do not always ask
enough/relevant
questions
They accept treatment
plan, sign the consent
form and ask questions
later
The Research
Lots of research around cancer and informed consent:
 Research shows that people with advanced cancer
should be better informed about treatment
implications for survival and quality of life.
 Audrey et al (2008) found that most patients are not
given clear information about the survival benefit of
palliative chemotherapy, with implications for
decision-making and informed consent.
 Munday and Maher (2008) say this study highlights
the need for more research into how to transfer this
information more effectively.
More Research
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This research should include the
development and evaluation of nationally
agreed and updated information, about the
prognosis of advanced cancer and benefits of
palliative chemotherapy.
Training should include guidance on how to
inform patients about the survival benefits of
such treatment. (communication)
Palliative Chemotherapy
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Informed consent is central to management decisions
in modern medical practice. However, sharing
information with patients about the value of
chemotherapy for advanced metastatic cancer is
highly challenging.
More than two-thirds of patients with cancer receive
little or no information about the survival benefits of
palliative chemotherapy before making treatment
decisions, (Audrey et al, 2008).
The research, published by the British Medical
Journal, recommends that benefits and limitations of
this treatment should be sensitively described,
including survival gain, to help with decision-making
and informed consent.
Communication Skills
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An editorial in the BMJ argues that patients need
up-to-date, consistent information and
comprehensive, expert communication from
oncologists and supportive care teams (Munday and
Maher, 2008).
Cancer clinical nurse specialists and other
practitioners are vital in ensuring patients are given
enough information to make informed decisions and
give informed consent for chemotherapy, and to
support them through this decision-making process.
Communication Skills
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General skills that healthcare
professionals should acquire to
improve patient experience include the
ability to:
Deliver information to patients
effectively
Work as part of an integrated
multidisciplinary team
Engage in appropriate 'what if'
conversations with patients
Overall
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To participate
effectively in informed
consent processes, you
should have the
knowledge, expertise
and capability to give
sufficient information
and be able to answer
any questions raised.
The Future
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Advanced communication skills for all cancer
specialists/staff
A standardised national consent form (NCAG
report 2008)
Opportunity to reassess patients
understanding of consent throughout
treatment pathway
More advanced practitioners taking and
explaining consent
Finally
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Patients have cognitive and emotional
limitations in understanding clinical information
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Better communication skills among
practitioners and more effective educational
resources are required to solve theses
problems
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Nurses often spend more time with the patient
and can therefore acknowledge some of the
practical difficulties in obtaining informed
consent