Informed Consent For Chemotherapy

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Informed Consent For Chemotherapy

• Angela Madigan
• Lead Chemotherapy Nurse for MCCN
• Macmillan Haematology CNS

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Contents

• What is informed consent?
• Why consent at all?
• Law and Ethics
• Department of Health
• The Role of the CNS
• Research
• Communication Skills

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What is Informed Consent?

• 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.
• There is a professional, legal, and moral
  consensus about the clinical duty to obtain
  informed consent.
• It is the method by which fully informed,
  rational persons may be involved in choices about
  their health care.

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Why Consent at all ?

• 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.

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Law and Ethics

• 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

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The Department of Health

• 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.

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Department of Health

• 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.

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The Role of the CNS

• 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 decision-making process.

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The Role of the CNS

• 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.

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In Reality

• 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

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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.

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More Research

• 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)

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Palliative Chemotherapy

• 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. 

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Communication Skills

• 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.

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Communication Skills

• 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

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Overall

• 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.

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The Future

• 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

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Finally

• Patients have cognitive and emotional limitations
  in understanding clinical information
• Better communication skills among practitioners
  and more effective educational resources are
  required to solve theses problems
• Nurses often spend more time with the patient and
  can therefore acknowledge some of the practical
  difficulties in obtaining informed consent

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