19.4 (5.4) Truth telling and consent

Question 1

List two ways why truth telling is important in Western medicine?

Answer 1

MD: legal and ethical responsibility

Patient: preserves autonomy

Question 2

A. List 3 preferred behaviours that can be employed for professionally telling the truth to a patient.

B. If the truth includes the fact there is no hope for a cure, what would you recommend to the patient?

Answer 2

A. 3 behaviours:
- being realistic
- providing an opportunity to ask questions
- acknowledging the person as an individual while discussing the prognosis

b. Goal is to find something realistic to hope for and tailor the care towards that goal

Question 3

A patient with leukemia requires a blood transfusion. In obtaining consent the patient is given a 3 page document to review and sign which contains institutional language.

• What is the downside to obtaining consent in this way?
• What would be the preferred way to obtain consent?

Answer 3

Downside = empty ritual in which patients are given complex info they cannot understand and have little impact on decision making

Preferred way = constant communication around all stages of medical decision making

Question 4

What information does a physician need to provide to a patient to fulfil the requirement of informing a patient for consent?

Answer 4

material risks of procedure (serious, life threatening), common risks/side effects, and alternatives to procedure

CMPA: (1) nature of the proposed investigation or treatment, (2) anticipated outcome, (3) significant risks involved and (4) alternatives available.

Question 5

The way a patient makes decisions is likely to change as they adjust to a new stage of illness. In the process of adjusting what three stages does a patient commonly cycle through?

Answer 5

comprehension (recognition of what has occurred)

creative adaption (experimentation with alternatives for living in the new circumstance)

reintegration (consolidation of the revised way of being)

Question 6

What are th3 benefits in involving family during health care discussions?

Answer 6

reduces risk of providing patient with unwanted care

reduce unnecessary and distressing hospital admissions

positive impact on difficult treatment choices

positive impact on initiation of palliative care

positive impact on EOL conversations in ICU settings

Question 7

Accomplishing effective truth telling is enhanced by considering six functions of communication that are needed for various phases of illness. What are the six functions?

Answer 7

Fostering healing relationships
exchanging information
responding to emotions
managing uncertainty 
making decisions
enabling patient self management

Question 8

Truth telling is an essential part of communication in palliative care.

• What tool can be used for telling the truth to a patient who needs to learn about an unfortunate new diagnosis of lung cancer?

Answer 8

S setting
P perception 
I invitation 
K knowledge
E empathy 
S strategy

Question 9

List 5 steps to follow when engaging in ACP (advanced care planning)

Answer 9

introduce the topic
engage in structured discussion
document the preferences of the person with illness
review and update those preferences regularly
apply directives when needed

Question 10

The family of a patient who is admitted to internal medicine and followed by palliative care is noted to be very upset after a discussion with the nephrologist.

• What might be driving the family to be upset as they engage with multiple care providers?
• What strategy can be used to support the family?

Answer 10

Inconsistencies in information about a condition can fuel conflicts

Family conferencing -> well-evidenced tool that can promote communication around goals of care and ACP