Informed Choice: Consent and Refusal
One
of the most challenging parts of any kind of health care
decision is informed choice. Many individuals simply agree
to whatever is proposed by their healthcare provider
without asking very many questions or doing their own
research. Some people seem to assume that the informed
consent papers they are handed leave them little choice to
refuse or to pursue different options.
A simple tool for assisting in making an informed choice is
the BREAD List:
B
–
Benefits
R
–
Risks
E
–
Education, Expectation, and Experience
A
–
Alternatives
D
–
Decision
Here is some help in building that conversation with your
healthcare provider. You can also use this to help build a
framework for doing your own research.
Benefits
This
part of the conversation seems to be fairly straight
forward. Your healthcare provider tells you all the
benefits of whatever this proposed treatment is. Simple,
right? Mmmm, maybe not!
What often happens is you get whatever benefits are most
likely to appeal to you and get you to agree to take the
proposed treatment. The benefits discussed are most likely
to be the ones that concern whatever issue brought you in.
Ok, so what is the issue here? Here are some questions to
ask:
- What research backs up the claim that this procedure, drug, etc will benefit you?
- Is it evidence-based research?
- How many people have found this option beneficial and for how long?
- What percentage of those who have tried this option have found benefit?
- Is this a standard, usual option for this issue?
- Is this something your health care provider can do, or will you have to see someone else?
- What does it cost in finances, in recovery time, in duration (i.e. do I have to do this til I die?) etc?
- If you have insurance, does it cover this option?
- At what point in time should I see results and if there are no results, at what point do we try something else?
Whether you like the answers you get or not, do some research yourself. Check out the identified issue and see where this option falls on the list of recommended options. Get a 2nd opinion, especially if the option is surgery, a pharmaceutical, or something that just doesn’t seem to fit your situation or seems to be unusual or experimental.
Risks
This part of the conversation often comes a little harder. Here are some guidelines for teasing out what you need to know:
- What are the known risks or side effects for this option – all of them, including the rare ones? Please be sure you understand all the side effects, and if you don’t, make sure you get a clear explanation in non-medical terms of what you don’t understand.
- What percentage of people who consent to this option suffer each of these risks – frequency, and severity?
- What pre-existing conditions do I have that may put me at higher risk for side effects?
- What could I do to minimize the risk of side effects?
- What should I look for in order to identify a side effect?
- What side effects need immediate attention?
Education, Expectation and Experience
The E in the BREAD List covers quite a bit of ground, so we will take each one independently.
Education –
- How did you learn about this option?
- How did the healthcare provider who might perform this option learn to do it?
- Where did your healthcare provider learn about it (Remember, for example, that if it’s a drug and the drug rep is the only source of his or her information, the source of information may be biased in both the efficacy and safety of the option and in what information they are willing to share.)
- Is the information behind this evidence-based and who paid for the studies?
- Is there some sort of continuing education source that the healthcare provider who performs the option uses to remain current?
- Is there special licensing or certification necessary or available to prove competency?
- How current is the education your healthcare provider has?
- And, if looking at another source for your education, how reliable is that source?
- Is the source you are using biased for or against certain options, and are they clear about those biases?
- What does the individual recommending this option expect that the result of this will be?
- What is your expectation for the option?
- Are they the same expectations?
- Does evidence-based research support the expectation?
- What is the time frame for achieving the expectation?
- At what point in time do you determine that the expectation is not being met and move on to something else?
- What experience level does the person who will administer the option have?
- What does their experience say about the efficacy and safety of this option?
- Can you talk to others who have chosen this option and see how they feel about the outcome?
- Is there someplace or some organization that might serve as a clearinghouse of information about your issue, so that you can see how others with similar circumstances have dealt with the condition?
Alternative
If I had to choose one of these items that is the hardest to get in the Informed Choice conversation, this is probably it. For every situation, there is more than one option, and often a great many options. For each an every alternative, you need to ask the same questions as you do for the originally proposed option! Understand that alternatives includes refusing the proposed option and that doing nothing is an option. These may or may not be the best options, but refusal to choose another option and doing nothing are options you have.
Check out both conventional medical options and alternative medical options. Balance benefits with risks on all fronts, so you have a realistic expectation of the outcome. Realize that in many instances, conventional medicine will not support alternative medical options, and vice versa. It’s the nature of the perspective each carries. However, as more and more people turn to alternative options, conventional medical providers are incorporating complementary options into their practice. You may simply have to research care providers more carefully to find someone who is knowledgeable in both kinds of options and is willing to support your choice.
Decision
And, this brings us to the final part – actually making an informed choice. The person who is most affected by the choice should be the person making the choice! Your healthcare provider, your best friend, your family member, etc may all be affected in some part by your decision, but you are the one who will have to live with the outcome.
You are the only one who knows which benefits and risks are most important to you and you are the only one who knows when the benefits outweigh the risks. Regardless of what choice you make, you have the right to be supported in your decision.
Where Abounding Health Stands
It is the absolute purpose of Abounding Health to support the decisions of clients in health care. You choose your goals,. You choose the path to the goal, You choose whether to follow that path or switch to another.
Where possible, Abounding Health will provide you with as much information as I have in my possession about options, but it is your responsibility to do some of your own research and to make the final choice. It’s your health – You choose!
Contact Information:
Kathy Barr, CCD, CCCE, CCM, BE, PE, CVE, Traditional Naturopath
817-819-8457
