Shared Decision-Making and Informed Consent: Enhancing Patient Autonomy

4 min readJun 19, 2023

Shared decision-making and informed consent are essential aspects of ethical medical practice. Obstetrician-gynecologists have a responsibility to provide patients with accurate information, ensuring their understanding of potential treatments and allowing them to make intentional and voluntary decisions regarding their care. This article explores the principles and practical application of shared decision-making and informed consent in the field of obstetrics and gynecology, focusing on adult patients in clinical practice.

Background

Informed Consent

Informed consent is rooted in the principles of patient autonomy and self-determination. It involves providing patients with relevant information about their medical condition, treatment options, and associated risks and benefits. The goal of informed consent is to support patients in making informed decisions regarding their healthcare. Essential elements of the informed consent process include assessing the patient’s understanding, presenting information accurately and sensitively, and documenting the conversation and decisions in the medical record.

Shared Decision Making

Shared decision making takes the informed consent process a step further by actively involving patients in discussions about available treatment options. It acknowledges that physicians’ values and priorities may differ from those of their patients. Through shared decision making, patients are encouraged to share information, express their preferences, and actively participate in developing a treatment plan. This approach respects patient autonomy while considering the broader context of their values and relationships.

The Ethical Obligations of Informed Consent

Meeting the ethical obligations of informed consent requires obstetrician-gynecologists to provide patients with adequate, accurate, and understandable information. Patients should have the ability to comprehend and reason through this information, ask questions, and make intentional and voluntary choices. The amount and complexity of information should be tailored to each patient’s preferences and comprehension level. It is crucial to address language and cultural barriers to ensure effective communication and reduce health disparities. The informed consent conversation should be well-documented in the medical record to demonstrate that ethical requirements have been met.

The Role of Shared Decision Making

Shared decision-making places patients at the center of the informed consent process. By engaging in shared decision making, obstetrician-gynecologists can better understand their patients’ values and priorities, enabling more personalized and patient-centric care. Reframing autonomy as “relational” recognizes the influence of patients’ interpersonal relationships and broader social environment on decision making. The SHARE approach, an example of shared decision making, provides a framework for effective communication and collaborative decision making.

Enhancing Informed Consent through Decision Aids

Decision aids, such as educational videos or printed materials, can facilitate shared decision making by providing patients with additional information and clarifying potential risks and benefits. These aids complement the discussion between patients and healthcare providers and can improve patient knowledge, reduce decisional uncertainty, and align care more closely with patient values. However, decision aids should not replace the ongoing involvement and support of obstetrician-gynecologists throughout the decision-making process.

Ethical Issues and Considerations

In the context of shared decision-making and informed consent, several ethical issues and considerations arise:

Decision-Making Capacity

Assessing a patient’s decision-making capacity is crucial to ensure that they have the ability to understand and participate in the decision-making process. Obstetrician-gynecologists must evaluate whether a patient has the capacity to make informed decisions based on their ability to comprehend relevant information, appreciate the potential consequences, weigh the options, and communicate their decision. In situations where a patient’s decision-making capacity is impaired, additional ethical considerations come into play, such as the use of advance directives or involving surrogate decision-makers.

Advance Directives and Surrogate Decision Making

Advance directives, including living wills and durable power of attorney for healthcare, allow individuals to express their healthcare preferences and appoint a surrogate decision-maker in case they become incapacitated. Obstetrician-gynecologists should respect and adhere to the wishes outlined in these directives when applicable. When patients lack decision-making capacity and do not have advance directives, the involvement of surrogate decision-makers, such as family members or legally appointed individuals, becomes necessary. Engaging in open and transparent communication with surrogate decision-makers is vital to ensure that the patient’s best interests and values are respected.

Conclusion

Shared decision-making and informed consent are fundamental to ethical medical practice, empowering patients to actively participate in their healthcare decisions. Obstetrician-gynecologists have a responsibility to provide accurate and understandable information, tailor communication to individual patients, and address language and cultural barriers. By engaging in shared decision-making, healthcare providers can enhance patient autonomy and improve the overall quality of care. The use of decision aids and consideration of ethical issues, such as decision-making capacity and advance directives, further contribute to an ethical and patient-centered approach. By prioritizing shared decision-making and informed consent, obstetrician-gynecologists can foster a collaborative and respectful healthcare environment.