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| 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.
Reference
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
