Informed Choice

This subject guide outlines five aspects of informed choice. It is intended as a quick reference guide for health care professionals.

Informed choice involves supporting patients* in making choices about their care. It is one of the cornerstones of good health care practice. Professional ethics and legal requirements impact what is important to address.

*Patients also means clients and residents.

Capacity

The ability to make health care decisions.

  • Assume that a patient has capacity unless there is evidence to the contrary.

Remember

  • Capacity is decision-specific and can fluctuate over time.
  • Capacity is often assessed informally in health care.
  • When assessing capacity formally, keep in mind:
    • To what degree is the patient’s ability to make an informed choice affected by their condition?
    • It is important to assess capacity in the best possible circumstances.
    • Some patients may benefit from additional support, but nonetheless retain their ability and authority to make their own decisions.

Disclosure

What would a reasonable person in this patient’s position want to know?

(Reibl v Hughes,1980, Supreme Court of Canada)

  • The condition for which treatment is proposed.
  • The nature and purpose of proposed treatment(s), including any relevant alternative and adjunct treatments.
  • The potential risks and benefits involved in undergoing proposed and/or alternative treatments, including any significant potential harms and the most common side-effects.
  • The potential risks and benefits in not having treatment(s).

Remember

  • The health care professional is responsible for sharing relevant information.
  • This responsibility can be delegated, but only to other health care professionals or learners who have the appropriate knowledge necessary to explain harms, benefits and alternatives, and to answer patient questions.
  • In a process of shared decision-making, information should come from both parties – this entails that disclosure and understanding apply to both patients and health care professionals.
  • Tailoring information for a particular patient can be helpful based on their needs, questions or values.
  • The patient may want to know the qualifications and experience of the health care professionals.

Understand and Appreciate

The ability to retain, comprehend, evaluate and apply the information provided for decision-making.
  • Does the patient understand and appreciate what they are being told?
  • Does the patient understand that they are an active participant in making decisions?
  • Do you have the information you need to help the patient understand and appreciate the implications of their choices?
  • What information sources is the patient relying on (e.g. social media, Google)?
  • Is the patient experiencing inconsistencies in the information provided to them?

Remember

In finding the most effective approach to communication, there are a variety of ways to help the patient to both understand and appreciate their choices about health care. Consider such things as language differences, cultural influences, and literacy levels.
Strategies to support understanding and appreciation include:

  • providing clearly written patient information sheets (translated versions too);
  • letting patients know a loved one or friend can be present with them;
  • asking patients to repeat in their own words what they understand; and/or
  • spreading discussions out over time, if possible.

Voluntariness

The patient is able to make decisions freely.
  • Are there influences on the patient that may be coercing or manipulating them to make certain decisions? If so, is there a way to address this?

Remember

  • It is important to think about what pressures may be placed on the patient to select a particular treatment (including the influence of friends and family,as well as health care professionals).
  • Sometimes it may be helpful to speak to the patient alone.
  • Patients may sometimes choose to make decisions based on their concerns for their loved ones.

Decision

At the end of the decision-making process a patient will either give consent for, or refuse, a particular treatment.
  • Is the patient simply agreeing to what was proposed, rather than making an informed choice about it?
  • Are you confident that the patient has made an informed choice (even if you don’t agree with the choice)?

Video

 Informed Choice

Nova Scotia Health Authority, 2018.