BENEFITS OF MEDICAL-MEDIATION IN INFORMED CONSENT: EVALUATING CLINICIANS’ PERSPECTIVES
DOI: 10.54647/cm32643 88 Downloads 5080 Views
Author(s)
Abstract
Ensuring shared decision-making processes between physicians and patients/families through informed consent (IC) is essential. However, information gaps and time constraints can make it difficult to achieve satisfactory IC. Therefore, medical-mediation by “a mediator” was conceived to address these issues. Medical-mediation solves problems by visualizing reasons for cognitive conflicts during dialogue. We investigated its usefulness in five IC settings conducted by five clinicians in Japan. Semi-structured interviews were conducted using five questionnaires after the same mediator-mediated IC. Data were qualitatively analyzed using KH Coder 3 developed by Koichi Higuchi. Clinicians’ ages ranged from 30 to 65 years, and the time required for IC was 7 to 15 minutes. In all the questions, none of the participants rejected medical-mediation. The co-occurrence network analysis showed a connection between “mediator” and "ease of explanation," "facilitating questions," and "sharing and obtaining information." In terms of IC time, characteristic words were "explanation" and "patient" for less than 10 minutes, and “family” for more than 10 minutes. In terms of clinicians’ years of experience, the characteristic words were "explanation" and "ease" for less than 9 years, and "family," "concrete," and "feelings" for more than 9 years. During medical-mediation, the mediator can be close to both parties, making it easier for both parties to ask questions and disclose more information spontaneously, such as addressing the patient's questions and concerns. The patients expressed their satisfaction with the IC. This study showed that clinicians' assessment by medical mediation is beneficial in the shared decision-making process of IC.
Keywords
clinician; decision-making process; facilitation; informed consent; medical- mediation
Cite this paper
Toshimi Nakanishi, Miyu Hayasaka, Eri Endo, Ayumi Tsuchiya,
BENEFITS OF MEDICAL-MEDIATION IN INFORMED CONSENT: EVALUATING CLINICIANS’ PERSPECTIVES
, SCIREA Journal of Clinical Medicine.
Volume 6, Issue 6, December 2021 | PP. 488-499.
10.54647/cm32643
References
[ 1 ] | Paterick, T.J., Carson, G.V., Allen, M.C. & Paterick, T.E. (2008) Medical informed consent: general considerations for physicians. Mayo Clin. Proc., 83, 313-319. |
[ 2 ] | Takimoto, Y., Maeda, S., Slingsby, B.T., Harada, K., Nagase, T., Nagawa, H., Nagai, R. & Akabayashi, A. (2007) A template for informed consent forms in medical examination and treatment: an intervention study. Med. Sci. Monit., 13, PH15-PH18. |
[ 3 ] | Abaunza, H. & Romero, K. (2014) Elements for adequate informed consent in the surgical context. World J. Surg., 38, 1594-1604. |
[ 4 ] | Kumar, S., Mohanraj, R., Rose, A., Paul, M.J. & Thomas, G. (2012) How ‘informed’ is informed consent? Findings from a study in South India. Indian J. Med. Ethics, 9, 180-186. |
[ 5 ] | Convie, L.J., Carson, E., McCusker, D., McCain, R.S., McKinley, N., Campbell, W.J., Kirk, S.J. & Clarke, M. (2020) The patient and clinician experience of informed consent for surgery: a systematic review of the qualitative evidence. BMC Med. Ethics, 21, 58, doi: 10.1186/s12910-020-00501-6. |
[ 6 ] | Berman, L., Curry, L., Gusberg, R., Dardik, A. & Fraenkel, L. (2008) Informed consent for abdominal aortic aneurysm repair: the patient’s perspective. J. Vasc. Surg., 48, 296-302. |
[ 7 ] | Waisel, D.B., Lamiani, G., Sandrock, N.J., Pascucci, R., Truog, R.D. & Meyer, E.C. (2009) Anesthesiology trainees face ethical, practical, and relational challenges in obtaining informed consent. Anesthesiology, 110, 480-486. |
[ 8 ] | Wood, F., Martin, S.M., Carson-Stevens, A., Elwyn, G., Precious, E. & Kinnersley, P. (2016) Doctors’ perspectives of informed consent for non-emergency surgical procedures: a qualitative interview study. Health Expect., 19, 751-761. |
[ 9 ] | Heaney, R.M., Murray, M., Heaney, A.M. & Doherty, E.M. (2019) “All by myself” interns’ reports of their experiences taking consent in Irish hospitals. Ir. J. Med. Sci., 188, 259-263. |
[ 10 ] | Pieterse, A.H., Stiggelbout, A.M. & Montori, V.M. (2019) Shared decision making and the importance of time. JAMA, 322, 25-26. |
[ 11 ] | Paterick, Z.R., Paterick, T.E. & Paterick, B.B. (2020) Medical informed choice: understanding the element of time to meet the standard of care for valid informed consent. Postgrad. Med. J., 96, 708-710. |
[ 12 ] | Wooldridge, A.N., Arató, N., Sen, A., Amenomori, M. & Fetters, M.D. (2010) Truth or fallacy? Three hour wait for three minutes with the doctor: findings from a private clinic in rural Japan. Asia Pac. Fam. Med., 9, 11. |
[ 13 ] | Kisa, K., Kawabata, H. & Maezawa, M. (2012) A systematic review of studies on consultation length in Japan. An Official Journal of the Japan Primary Care Association, 35, 37-44. |
[ 14 ] | Irving, G., Neves, A.L., Dambha-Miller, H., Oishi, A., Tagashira, H., Verho, A. & Holden, J. (2017) International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open, 7, e017902. |
[ 15 ] | Anderson, E.E., Newman, S.B. & Matthews, A.K. (2017) Improving informed consent: stakeholder views. AJOB Empir. Bioeth., 8, 178-188. |
[ 16 ] | Kaibara, P.D. (2010) 8 Ways to improve the informed consent process. J. Fam. Pract., 59, 373-377a. |
[ 17 ] | Hall, D.E., Prochazka, A.V. & Fink, A.S. (2012) Informed consent for clinical treatment. CMAJ, 184, 533-540. |
[ 18 ] | Glaser, J., Nouri, S., Fernandez, A., Sudore, R.L., Schillinger, D., Klein-Fedyshin, M. & Schenker, Y. (2020) Interventions to improve patient comprehension in informed consent for medical and surgical procedures: an updated systematic review. Med. Decis. Making, 40, 119-143. |
[ 19 ] | Kearns, C., Kearns, N. & Paisley, A.M. (2020) The art of consent: visual materials help adult patients make informed choices about surgical care. J. Vis. Commun. Med., 43, 76-83. |
[ 20 ] | Nakanishi, T. (2015) Informed consent by medical mediation has a positive effect on patient satisfaction. Med. Confl. Manag., 4, 11-20 (in Japanese). |
[ 21 ] | Nakanishi, T. (2013b) Effects of mediator skill training for facilitating disclosure process after adverse events. Asian J. Med., 14-25. |
[ 22 ] | Nakanishi, T. (2013a) New communication model in medical dispute resolution in Japan. Yamagata Med. J., 31, 1-8. |
[ 23 ] | Higuchi, K. (2004) Quantitative analysis of textual data: differentiation and coordination of two approaches. Sociol. Theor. Methods, 19, 101-115 (in Japanese). |
[ 24 ] | Japanese Society of Internal Medicine (2017) About Internal Training Doctor for New Medical Speciality System (in Japanese).www.naika.or.jp/nintei/shinseido2018-2/20171225_shidoi/ [Accessed: April 3, 2020]. |
[ 25 ] | Japanese Medical Specialty Board (2019) Specialist certification / renewal summary (in Japanese). https://jmsb.or.jp/senmoni#an02 [Accessed: April 3, 2020]. |
[ 26 ] | Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording, E., Tomson, D., Dodd, C., Rollnick, S., Edwards, A. & Barry, M. (2012) Shared decision making: a model for clinical practice. J. Gen. Intern. Med., 27, 1361-1367. |
[ 27 ] | Grady, C. (2015). Enduring and emerging challenges of informed consent. N. Engl. J. Med., 372, 855-862. |
[ 28 ] | Moreau, D., Goldgran-Toledano, D., Alberti, C., Jourdain, M., Adrie, C., Annane, D., Garrouste-Orgeas, M., Lefrant, J.Y., Papazian, L., Quinio, P., Pochard, F. & Azoulay, E. (2004) Junior versus senior physicians for informing families of intensive care unit patients. Am. J. Respir. Crit. Care Med., 169, 512-517. |
[ 29 ] | Gray, D., Hood, H., Haworth, G., Smyth, C. & Linklater, G. (2018) Hospital doctors’ experiences of caring for dying patients. J. R. Coll. Physicians Edinb., 48, 299-303. |