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Consultation skills for shared decision making should be used to prepare patients for anaesthesia, surgery and analgesia. Patients should also be informed of the increasing number of decision aids available from NHS Direct to help them with their choices.66,102,103 The use of shared decision making tools such as ‘Benefits, Risks, Alternatives, Nothing’ and ‘Ask 3 questions’ should be considered.104,105
Information should be provided sufficiently far in advance to allow the patient to consider and reflect on this information prior to anaesthesia and surgery.
Patients from non-English speaking groups may require interpreters. Wherever possible, this need should be identified in advance.101 Hospitals should have arrangements in place to provide language support, including interpretation and translation services (including sign language and Braille).101,107,108,109,110 Patients with learning and other difficulties may require special assistance and consideration.
The Mental Capacity Act, Adults with Incapacity (Scotland) Act or the Mental Capacity Act (Northern Ireland) must be complied with.111,112,113 Staff should have regular training in the application of the Mental Capacity Act and have defined access to patient advocates. This is a rapidly changing area, and clinicians should have access to expert advice if...
Some patients, both adults and children, may need parents or other members of their family to be with them. This need is best determined at the preassessment clinic visit, so that sensitivities can be taken into account in the operative process.39
All practitioners must follow the practices outlined in the GMC Decision making and consent guidance. Documentation of the risks discussed or the dialogue leading to a decision is required in accordance with paragraphs 50–55.67 Equally, completion of a consent form is not a substitute for a meaningful dialogue tailored to the individual patient’s needs.
Ideally, as part of shared decision making, consent for surgical and anaesthetic procedures should be obtained prior to the day of surgery (see recommendation 4.3), allowing sufficient time for the patient to reflect on their consent discussion.67 The competent patient has a fundamental right, under common law, to give, or to withhold, consent to examination, investigation and treatment.66,67,99
Where a patient is seen prior to the day of surgery and shared decision making and discussion of anaesthetic conduct has taken place, the anaesthetist on the day of surgery has a responsibility to ensure the patient still understands and agrees with the perioperative plan.66,67
The patient must be made aware of alternative treatment options, or the option for no treatment at all. It is acceptable to recommend one of the alternatives but as the GMC states ‘The doctor may recommend a particular option which they believe to be best for the patient, but may not put any pressure onto the patient to accept their...
No other person can consent to treatment on behalf of any adult. If a health and welfare lasting power of attorney directive is in place, the attorney may be able to assent to treatment on behalf of the patient. There should be a local process and policy in place for patients who lack capacity that conforms to national guidance and...
