Global considerations for informed consent with shared decision-making in the digital age

Abstract

Shared decision-making (SDM) is increasingly recognised as fundamental to patient-centred care and enabling patients to make voluntary, informed decisions about their health.1 SDM is the process whereby patients and clinicians come together to share their expertise. The patient acts as an expert of themselves, understanding their own preferences and their attitudes to risk. The clinician is an expert on the medical knowledge and scientific evidence. Together, treatment options should be explored, arriving at a treatment decision that is right for the patient and supported by the clinician. When dealing with invasive or high-risk procedures (eg, operations, chemotherapy, radiotherapy, immunotherapy), once the treatment decision has been made, the conversation turns to informed consent. This is the process of communicating and agreeing to the potential risks and benefits of the procedure, while acknowledging that there are alternative treatment options that have not been chosen. Though informed consent should be the culmination of SDM, alone it does not encapsulate the entire process. There is a distinction between decision-making and consent and this should ideally be accompanied by a period for reflection. Despite advances in SDM, the subsequent informed consent process has remained stagnant, often failing to meet ethical or legal standards of supporting meaningful patient autonomy.2 In reality, rapid surgical decisions may be required (e.g. emergency or cancer pathways), where time is a precious commodity to deliver optimal patient care. In these scenarios, it is common for discussions to move quickly from diagnosis to treatment options, to consent. However, scarcity of clinician time should not be an excuse for inadequate consent. Therefore, reimagining the consent process in the digital age by ensuring the benefits, risks and alternative treatment options are clearly and correctly presented as early as possible, has the ability of transforming this step from a ritualised gesture into a …