Informed Consent & Patient-Centred Care

Question 1

Define “assault”

Answer 1

Striking, touching, moving or applying force directly or indirectly to a person without their consent, or if the consent is obtained by fraud; or threatening to do so

Question 2

What does “applying force” refer to?

Answer 2

Applying heat, light, electrical force, gas, odour or any other substance or thing that will cause injury or personal discomfort

Question 3

Define “negligence”

Answer 3

Failure to exercise reasonable care and skill

Question 4

When is a person negligent?

Answer 4

When the risk was foreseeable and significant and a reasonable person would have taken precautions

Question 5

What 3 elements must be proven to recover compensation for alleged negligence?

Answer 5

1) There was a duty of care to the patient
2) There was a breach of that duty
3) The injury the patient sustained was caused by the breach of duty

Question 6

What are material risks?

Answer 6

Risks that have particular significance for the patient

Question 7

Define “informed consent”

Answer 7

When a person has given consent based on an appreciation and understanding of the facts and implications of an action. The person must have the relevant facts and reasoning facilities at the time of consent

Question 8

What are the components of informed consent?

Answer 8

• Does the patient understand? (Age, mental capacity, language)
• Rights (right to withdraw consent at any time)
• Condition
• Treatment/intervention options
• Costs
• Risks (general, specific/significant, risk of doing nothing, uncertainty)
• Who will be performing the procedure

Question 9

What are the four elements that result in consent being valid and informed?

Answer 9

1) Patient is competent to give consent
2) Full information of risks, benefits, alternatives and costs has been provided
3) Consent is freely given
4) Consent is specific to the procedure

Question 10

Why is informed consent important?

Answer 10

Autonomy of the individual is protected by law, ethics & codes of conduct, things can go wrong

Question 11

What is the most common allegation associated with poor informed consent?

Answer 11

Complication not mentioned

Question 12

What are the 4 considerations associated with patient-centred care?

Answer 12

1) Body systems
2) Life stage (i.e. age)
3) Diversity (i.e. background, culture, disability)
4) Settings (i.e. hospital, workplace, recreation)

Question 13

What does the Health Professionals Act 2004 deal with?

Answer 13

People pretending to be health professionals, registration of practitioners, health professionals misbehaviour, reporting misconduct

Question 14

When is consent waived for a physio?

Answer 14

When the patient is unconscious but breathing (put in recovery position) or when the patient is unconscious and not breathing (commence CPR)

Question 15

What are the 6 key expectations for patients with CLBP?

Answer 15

• The physio
• Communication
• Individual care
• Decision-making
• Information
• Organisation of care

Question 16

What are the two key attributes of a good physiotherapist, as perceived by patients?

Answer 16

Competence (know what they’re talking about, great depth of knowledge) and personality (friendly, professional, caring)

Question 17

Why is there a complex combination of factors associated with patient-centred care?

Answer 17

Because patients who describe their physio as nice or competent don’t necessarily perceive their treatment as being patient-centred and are not always satisfied

Question 18

How does communication play a role in individual care?

Answer 18

Listening, understanding, getting to know the patient, allowing the patient to explain their problem and question the physio

Question 19

How is decision-making linked with communication in patient-centred care?

Answer 19

Patients tend to be happy for the physio to make most decisions as long as they are accompanied by good explanations

Question 20

How much information should a physio provide to a patient?

Answer 20

As much information as they can confidently provide about the diagnosis and what it means for them, or if there is no specific diagnosis, e.g. it could be one of these 3 options

Question 21

What are the most important elements of organisation of care?

Answer 21

Access to physio (waiting times, amount of treatment, return access) and clarity over onward referral

Question 22

What are the 4 elements of “expert” patient-centred care?

Answer 22

• Values & virtues
• Clinical reasoning/empowerment/collaborative problem-solving
• Clinical practice style
• Knowledge

Question 23

Therapists classified as experts have a patient-centre approach to care, characterised by what?

Answer 23

Collaborative clinical reasoning and promotion of patient empowerment

Question 24

What are the 3 approaches to goal setting in regards to engaging a patient?

Answer 24

Therapist controlled, therapist led, patient-centred

Question 25

What are the clinical implications of patient-centred care?

Answer 25

- Identifying and addressing psychological factors - Facilitating the decision-making process - Establishing a conducive learning environment - Facilitating self-management - Enhancing communication

Question 26

What are 3 psychological models physios can use to enhance their skills in facilitating self-management?

Answer 26

- Self efficacy component of social cognitive theory - Transtheoretical model - Motivational interviewing

Question 27

What is the transtheoretical model?

Answer 27

Precontemplation - Contemplation - Preparation - Action - Maintenance