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Standards for general practices (4th edition)

including Interpretive guide for Aboriginal and Torres Strait Islander health services

Standard 1.2 Information about the practice

Our practice provides sufficient information to enable our patients to make informed decisions regarding their care.

Criterion 1.2.2

Informed patient decisions

Our practice gives patients sufficient information about the purpose, importance, benefits, risks and possible costs associated with proposed investigations, referrals or treatments, to enable patients to make informed decisions about their health.

Indicators

► A. Our clinical team can demonstrate how we provide information to our patients about the purpose, importance, benefits, risks and possible costs of proposed investigations, referrals or treatments.

► B. Our clinical team can describe how we use leaflets, brochures or written or electronic information to support our explanation of the diagnosis and management of conditions when appropriate.

► C. Our clinical team can describe how we provide information (printed or otherwise) about medicines and medicine safety to patients.

Explanation

Key points

Appropriate and sufficient information

It is important that patients have sufficient information to make appropriate decisions about their own healthcare. Information about the purpose, importance, benefits, risks and possible costs of proposed investigations, referrals or treatments needs to be tailored to the individual patient’s needs.

This information needs to be delivered in appropriate language and format – avoid the use of jargon or complicated terms – and where necessary include clear diagrams and written information. Consideration also needs to be given to the patient’s physical, visual and/or cognitive capacities, which may impact on their ability to understand the information, make decisions or provide consent.

Consideration needs to be given to the way information is communicated in relation to potentially sensitive investigations or tests (eg. sexually transmissible infections, blood borne viruses, fetal abnormality screening and pregnancy tests).

If working with patients from a different cultural background, special care is needed to ensure there is a shared understanding between the GP and the patient about the information provided.

In situations where patients are dependent on a third party for their ongoing care it is important to ensure all appropriate information is also provided to carers.

Although it is not necessary for the practice to know the exact costs of referred services, patients need to be advised of the potential for out-of-pocket costs before a referral is made. Where patients require exact information about the costs of referred services they can be invited to make their own enquiries. If the patient indicates that such costs pose a barrier to the suggested referral, alternatives may need to be discussed (eg. referral to public services).

Informed consent also applies to any research being undertaken by a member of the practice team, in accordance with the NHMRC ‘National statement on ethical conduct in human research’ (www.nhmrc.gov.au/publications/synopses/e72syn.htm).

Patient-doctor collaboration

The Australian Commission on Safety and Quality in Health Care encourages patients to actively discuss with their healthcare provider the purpose, importance, benefits and risks associated with their care. The publication ‘10 tips for safer healthcare’ is available at www.health.gov.au/internet/safety/ publishing.nsf/content/10-tips and provides further detail. Practices may find it useful to refer patients to this information to help create an understanding of shared responsibility between the patient and the practice.

If a GP is aware that a patient has decided not to follow the advice of the GP after receiving sufficient information to make an informed decision about their care, their refusal and their awareness of its implications, as discussed with the GP, should be documented in the patient health record (see Criterion 2.1.1 Respectful and culturally appropriate care).

Medicines

The provision of information about medicines and medicine safety including consumer medicines information (CMI) may assist patients to make informed decisions about their medicines. Consumer medicines information provides an online version of leaflets produced by pharmaceutical companies and is available to the general public at www.nps.org.au/medicines.

GPs could offer to discuss any issues about medicines that could be confusing to patients and could also usefully suggest that patients obtain information about their medicines from their pharmacist.

Standard 1.2 Information about the practice

Our practice provides sufficient information to enable our patients to make informed decisions regarding their care.

Criterion 1.2.2

Informed patient decisions

Our practice gives patients sufficient information about the purpose, importance, benefits, risks and possible costs associated with proposed investigations, referrals or treatments, to enable patients to make informed decisions about their health.

In a nutshell

Your clinicians provide information about any investigation, referral or treatment they suggest, so that patients can make informed decisions about their health. This information includes:

  • why the clinician is suggesting an investigation, referral or treatment
  • 
how important it is that the patient follows the suggestion
  • 
what benefits the suggested investigation, referral or treatment will have
  • 
what things might go wrong and how likely and serious they might be
  • 
any possible costs associated with an investigation, referral or treatment.

Key team members

  • Practice manager
  • Health service doctors
  • Other clinical staff (under direction of the doctor)

Key organisational functions

  • Patient communication
  • Communication policies
  • Documenting patient health records
  • Informed consent policy
  • Informed patient decision-making
  • Clinical resources
  • Cultural resources

Indicators and what they mean

Table 1.6 explains each of the indicators for this criterion. Refer to Criterion 1.2.2 Informed patient decisions of the Standards for general practices for explanations of some of the concepts referred to in this criterion. 

Table 1.6 Criterion 1.2.2 Informed patient decisions
IndicatorsWhat this means and handy hints
▶ A. Our clinical team can demonstrate how we provide information to our patients about the purpose, importance, benefits, risks and possible costs of proposed investigations, referrals or treatments. The information you provide to your patients about their healthcare needs to be clear, easy to understand and as free of medical jargon as possible.

When your clinical staff propose an investigation, referral or treatment to patients, they are advised to clearly state its:
  • purpose
  • importance
  • benefits
  • risks
  • possible costs.
How you communicate information is just as important as what you communicate. It needs to be delivered in simple, clear language. Where appropriate, you could use diagrams or pictures as well as written or spoken words for patients with limited visual, language and literacy skills, or whose first language is not English.

It is important that your clinical staff consider patients’ physical, visual or cognitive capacity to understand the information being provided. Similarly, language and cultural differences need to be considered when discussing the information so that both patient and doctor have a shared understanding of the issue at hand.

It is also important that your staff avoid assuming patients understand everything they have been told. This is especially important if your clinicians and patients are from different cultural backgrounds. Your staff could also check to make sure patients understand, and allow enough time for them to take in and talk about all the information. It may take several sessions for a good understanding to be developed on both sides.

Where there is a carer involved, you will need to provide information to the carer as well as the patient.
 B. Our clinical team can describe how we use leaflets, brochures or written or electronic information to support our explanation of the diagnosis and management of conditions when appropriate. Your clinical staff can show the range of additional clinical and other resources they use when explaining to patients the diagnosis and treatment of conditions. This could include leaflets, diagrams, brochures, information sheets, computerised programs and the internet.

In culturally diverse contexts, this could also include clinical staff working with interpreters, cultural brokers or Aboriginal health workers to provide the information to patients. Culturally appropriate graphics may also be useful if there are language differences between your clinicians and patients.

When a patient refuses care or does not follow a doctor’s advice after they have been given enough information to make an informed decision, the doctor should record that refusal in the patient’s health record.
 C. Our clinical team can describe how we provide information (printed and otherwise) about medications and medicine safely to patients. Clinical staff need to know if your service provides this information through leaflets, diagrams, brochures, information sheets, computerised programs or the internet, and be able to communicate this to patients. For some patients your staff may need to include verbal communications.

Case study

Below is a description of the ways in which an Aboriginal community controlled health service can ensure its patients are given enough information to make informed decisions. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community. (See also the case study for Criterion 5.3.1 Safe and quality use of medicines.)

The health service maintains a shame-free, non-judgemental environment, to ensure patients don’t feel embarrassed to ask questions about their treatment. The service has proper information and communication systems to ensure GPs and their patients have a shared understanding about all aspects of proposed investigations, referrals or treatments. The aim of the service is to improve patients’ health literacy so that they can make informed decisions and participate in managing their own health.

The health service has a range of visual resources for GPs and other health professionals to use when explaining their recommendations for patients. Some of these resources have been developed by external organisations familiar with the culture and language of local community groups, and they often include graphics to communicate important messages.

GPs take as long as they need to explain things in order to help patients make appropriate decisions. Often, they will also check to ensure patients understand what they have said; to do this, they may use tools such as the teach-back technique (see Useful resources). GPs will often show patients the information they themselves use – such as charts, recommendations and relevant decision-support tools. In addition, there are many charts and posters on the wall of the consulting room that GPs can show to patients when discussing their health and offering recommendations. Where necessary, an Aboriginal health worker will also participate in the consultation, to further assist communications.

If a lot of complex information is discussed during an appointment, at the next one the GP will ask the patient how they went with the previous session. This is to check whether they have thought about it or talked about it with other people, or if they may need to discuss it again with the GP.

The health service offers a patient-assisted transport scheme to assist remote patients to travel into town for specialist or hospital appointments. This provides an opportunity for patients to discuss proposed treatments or procedures directly with the specialist or surgeon.

The health service policy manual has clear guidelines on what constitutes informed consent and how this is to be documented in patient health files. These files (electronic or paper-based) contain documented evidence of signed consent forms for procedural treatments.

Staff members organise for pharmacists to do a home medicines review for patients who require it under the QUMAX program, where it is available.

Staff members provide patients with handouts that provide information about medicines, including instructions for use, possible side effects, when to seek advice or potential problems. Staff also use flip charts on the use of medicines and demonstrate how to use inhalers and spacers.

Showing how you meet Criterion 1.2.2

Below are some of the ways in which an Aboriginal community controlled health service might choose to demonstrate how it meets the requirements of this criterion for accreditation against the Standards. Please use the following as examples only, because your service may choose other, better-suited, forms of evidence to show how it meets the criterion.

  • Use diagrams in consultations to explain health problems.
  • Use flip charts.
  • Document in health records that possible risks or side effects associated with treatment options have been discussed and explained.
  • Ensure health videos are available in the service for patients to view.
  • Show that information sheets and instructions on medicines are given to patients when new medications are prescribed.
  • Show that with patients’ permission a cultural broker or carer is included in the consultation to assist with clarifying information when required.
  • Make available a range of one- to two-page health information sheets.
  • Ensure various Aboriginal-specific health brochures are available in the waiting room and consultation rooms.
  • Ensure that refusal of any doctor’s advice is documented in the patient health records.
  • Have posters up on the service’s walls.

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