|Getting consent in veterinary practice can be tricky for a number of reasons. Cartoon by Aileen Devine, conceived by Anne Fawcett.|
Have you ever signed a consent form? Do you read the fine print? Do you feel like you’re signing over your rights? What goes through the mind of veterinary clients when they sign a consent form? These are really important questions to ask, and UK veterinarians have done just that.
Martin Whiting and colleagues surveyed 470 clients from the Queen Mother Hospital for Animals about the consent process and the findings are surprising.
To backtrack slightly, informed consent in medicine is a concept that was developed to ensure that patients have autonomous choice, and to protect their interests. In veterinary medicine consent is never obtained from the patient (another can of worms that I’m working on a paper about at the moment), but
from the owner/guardian or client.
It usually also includes agreement about expected costs.
When asked about signing consent forms, most clients recalled signing forms (records indicated that 100 per cent signed a consent form – this was an inclusion criteria for the study).
But the majority of these found the process disempowering – the opposite of what it’s meant to be.
More than half did not read the form – 60 per cent “trusted their veterinarian”.
Most (71 per cent) felt that the consent process explained the proposed procedure/procedures in a way they could understand, and 77 per cent felt they could understand potential risks. Yet 33 per cent felt frightened by the process.
Only 15 per cent felt in control of their choices. Half (51 per cent) did not feel in control, nor reassured (51 per cent) by the consenting process.
Almost half (45 per cent) believed that consenting removed their right to compensation for negligence, while 31 per cent felt the veterinarian could do something different from the agreed procedure anyway. More than one third of clients did not realise that they could change their mind. And 7 per cent did not understand what the consent form meant.
These findings are interesting. It’s not known whether similar findings apply in a general practice setting – animals attending referral hospitals like the Queen Mother Hospital for Animals may be undergoing advanced, invasive or higher risk procedures. The authors indicate that they may undertake further studies to determine if this is the case.
What can be done?
The study found that it wasn’t about time – 96 per cent of clients were satisfied with the amount of time offered to consider a procedure before consenting.
But better communication may be helpful. For example, some people dismissed the form as a standard agreement and therefore didn’t read it, others were too worried to read the form (suggesting scope to address further concerns), and some just preferred to listen to the vet’s explanation. The study found that clients want to hear about a few treatment options, risks of procedures and treatment, prognosis and an estimate of fees. They want the opportunity to ask questions about the treatment, and they want to be talked through the aftercare.
From a client’s point of view, what might help the process? Asking for more time to consider a process if needed, getting a second opinion (not always possible in the case of emergencies but possible for some procedures), and telling the vet what you are most concerned about (is it the anaesthetic? Is it the procedure itself? Do you feel that there’s something else you would like the vet to look at before proceeding? Is it the recovery or post-operative care?). As a consumer of health care services (including veterinary services) myself, I want to know as much about potential risks and benefits that the vet can impart, and I seek out a clinician who seems to genuinely care.
As the authors suggest, perhaps we also need two different consent forms – one regarding a fee estimate, and another regarding procedures. By combining the two, some clients may feel that the consent form is simply an instrument that the hospital uses to ensure it gets paid, i.e. to protect its own interests. By signing two different forms, it may be clearer that consent to procedures is about ensuring informed consent and protecting the interests of the client/patient. Of course, additional forms increase administrative load and may not be favourably perceived by clients.
It would be really interesting to find out and compare vet’s perceptions of the consent process.
You can read the paper here.
Whiting M, Alexander A, Habiba M & Volk HA (2017) Survey of veterinary clients’ perceptions of informed consent at a referral hospital. Veterinary Record January 7, doi 10.1136/vr104039