Informed Consent For Chemotherapy

Angela Madigan

Lead Chemotherapy Nurse for MCCN

Macmillan Haematology CNS

Contents

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?

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.

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.

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

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.

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.

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.

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.

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

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

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

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

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

General skills that healthcare professionals should acquire to improve patient experience include the ability to:

1. Deliver information to patients effectively

2. Work as part of an integrated multidisciplinary team

3. Engage in appropriate 'what if' conversations with patients

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.

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

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