Wednesday, December 21, 2011

Do mandated disclosure forms like (informed consent, Truth in Lending Act etc) work?

Watch this video, and you might think that helping patients better understand if a coronary stent is going to benefit them might be best accomplished by mandating a better informed consent process.

The use of patient specific, tailored informed consent forms might indeed improve the process of helping patients making treatment decisions that are better aligned with their preferences.

But before you write your congressman requesting that the informed consent process be improved, you might want to consider this interesting paper  from University of Chicago that explains what the informed consent process shares with the Truth in Lending act (hint--mandated disclosures frequently fail miserably to achieve their intended purpose, and have many unintended adverse consequences).

How to address this problem today, if you are having to make a treatment decision?  The DSP blog still thinks this approach is not a bad place to start.

Monday, December 19, 2011

Friends don't let friends consent for a stent uninformed

The DSP blog was saddened when it read this study which asked a simple question:  do patients about to undergo a stent for stable angina correctly understand the expected benefits.  The key finding of this study:  88% of the patients that were getting a stent thought that the stent would "reduce their risk for MI" (myocardial infarction).  Why is this a problem?  Why is the DSP blog exhibiting grinch-like behavior by blogging about this so close to Christmas?  It is a problem because of what this study told doctors about the benefits of stents for stable angina:  the COURAGE trial demonstrated that stents do not reduce the chance of MI compared to medical therapy.

In the DSP's humble opinion, this discrepancy between what is known about the benefits of stents for elective angina, and what patients who are going to get a stent think the benefits are--this is the proverbial canary in the coal mine warning.  If the current system does not facilitate patients arriving at a correct understanding about how a stent for elective angina will and won't do for them, this really signifies a major problem in doctor patient communication.

The DSP blog's recommendation:  Besides reading the DSP blog, if you are pursuing any elective procedure, you better know enough to ask, and ask enough to know.  Asking the right doctors the right questions (see related post on this blog) is a good place to start.