Understanding Informed Consent and decision making from a Case Manager’s point of view:
Informed consent is a legal document which when signed, indicates permission for a health related procedure based on information provided by the health practitioner. The person undergoing the procedure should be given information detailing risks vs. benefits and the purpose for the procedure. The document assumes you are legally and cognitively able to make decisions for yourself or on behalf of someone who is unable to make those decisions.
The general intent of informed consent in an altruistic one. In theory and with practical and ethical application, what it does for individuals, is create a channel of expanded communication and education. In its basic form, informed consent should provide explicit information that leads to decision making.
It’s important for health practitioners to consider varying factors to determine the efficacy of the signed document. It’s also important to remember that if a person is in a position where an informed consent is to be signed, it’s likely a highly emotional time. What could be viewed as the presentation of complex information will like create great confusion. It’s important to make sure the individual or their representative has all the information they need to make an educated decision. Alternative solutions should be presented and the cost for different options should be presented as well.
Because we operate in a multi-cultural society, cultural implications has to be considered. Equally important are, socio-economic, educational limitations and cognitive limitations. Ultimately, decisional capacity is a strong determinant of an acceptable signed informed consent document.
Furthermore, determining cognitive abilities is not a simple endeavor. Cognitive assessments from either a Neurologist or a Psychiatrist is sometimes necessary to determine cognitive incompetence.
Assessments are the most effective method used to capture information that can lead to accurate diagnosis. Employing multiple assessment tools provides opportunities to evaluate the patient holistically. Psychosocial assessment tools assess the cognitive state and helps with appropriate intervention and care planning. It’s also important to understand the family dynamic, the financial state and healthcare needs of the patient.
If it has been determined that a patient has cognitive issues, a leading question for the Case Manger should be, is there an Advanced Directive? Is there a Power of Attorney in place? What other legal documents are in place and are they current and up to date? What’s the economic status? Income and assets would have to be evaluated to determine what the person can or can’t afford and eligibility for entitlement programs. Is there a social support system in place?
If an Advanced Directive is in place, the first step is to determine what arrangements have been made and what the explicit wishes of the patient are. When you have a person who has severe cognitive issues to the point of incapacity, the primary concern is to find appropriate care for that person and to make decisions that are in their best interest. Most important is providing a team of people who understand the needs of someone who is cognitively impaired, making sure they equipped to handle the progression of the impairment.
Those are all important elements when the number one goal is care and stability for the client.
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