Radiologist’s Guide to Informed Patient Consent

One of the most important issues facing radiology – both diagnostic and interventional – is informed patient consent, Stuart G. Silverman, MD, Harvard Medical School professor of radiology and director of abdominal imaging and intervention at Brigham and Women’s Hospital, said at RSNA 2015.

Along with colleagues, Silverman published a study in the Journal of Vascular Interventional Radiology November issue that discussed how vital informed patients are.

“Informed consent requires patient involvement, and this will happen even more so in the future,” he said. “Patients must understand their condition and the procedure, and they must also understand the benefits and risks presented by any proposed procedure.”

And securing proper informed consent means covering three key aspects. The interaction must be patient-centered, legally-sound, and quality-driven.

Patient-centered
Before presenting a patient with a written consent form and asking for a signature, take the time to get to know him or her. Learn what a patient believes about a procedure and what the desired outcome is. Explain the procedure fully, but be prepared to close the conversation without a consent signature.

“Consent is a collaborative goal, and a patient must know you’re working together to meet his or her wants,” Silverman said.

Legally-sound
The law protects patient autonomy above all else. Be sure the patient understands that nothing will happen without his or her permission, and provide details about risks and benefits, alternatives, and the potential outcomes for all options. Remember that, in many cases, a signed consent form isn’t valid if a patient signs without truly understanding everything about the procedure.[[{"type":"media","view_mode":"media_crop","fid":"44000","attributes":{"alt":"Stuart G. Silverman, MD","class":"media-image media-image-right","id":"media_crop_6280524393394","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4892","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Stuart G. Silverman, MD","typeof":"foaf:Image"}}]]

One caveat, according to Beth Ripley, MD, PhD, Silverman’s study co-author, is if you consistently use the same procedure to consent patients.

“If you consent patients routinely the exact same way, it’s called ‘usual and customary practice,’” she said. “It’s a very strong defense if a patient enters into litigation.”

Quality-driven
Existing studies show care quality improves when a patient understands a procedure and his or her role in it. For example, if a patient knows to stop taking a medication before a procedure, medical errors drop.

Use the teach-back method to ensure patients have understood you, Silverman said. After you finish your explanation, ask the patient to explain it to you in his or her own words. If they can’t, start over, and try again.

To effectively consent your patient, Silverman suggested following a mental checklist. However, as with disclosure conversations don’t treat it like a script. Instead, use it as a guide to walk through ensuring your patient fully understands the proposed procedure, as well as the risks and benefits.

When gaining consent, he recommended these four steps:

• Preparation: Get to know your patient. Familiarize yourself with any labs, social history, or cultural characteristics. Do they need an interpreter?

• Introduce Yourself: State your role in the patient’s medical care, and include whether you’re a resident. Encourage the patient’s active participation, and talk about his or her goals and desired outcomes.

• Core: Discuss the proposed procedure. Tell the patient who will conduct it, how long it will last, how it will be done, what the risks and benefits are, and whether there will be any pain. Explain all this in layman’s terms.

• Review: After you’ve explained everything, double back and check your efforts. Be sure to read through the written consent for with the patient.

No matter what type of conversation you’ve had with your patient, it’s imperative that you try to end well, Brown said. Review all the information you’ve provided and highlight any next steps. And, above all else, work to secure the patient’s confidence in you as a provider.