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Standards for health services in Australian prisons

Criterion 1.2.2 Informed patient decisions

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


Indicators

A. Our medical and other clinical staff can describe how they inform patients about the purpose, importance, benefits and risks of proposed investigations, referrals or treatments (interview).

B. Our medical and other clinical staff can describe how they use written information to support their explanation of the diagnosis and management of conditions when appropriate (interview).

C. Our medical and other clinical staff can describe how they provide information (printed or otherwise) about medicines and medicine safety to patients (interview).

D. Our medical and other clinical staff can describe how patients are advised of any potential costs when they are referred for investigations, or for consultations with a medical specialist or allied health professional, including the cost of transport and any prison staff chaperone that may be associated with the referral (interview).


Explanation

It is important that patients have sufficient information to make appropriate decisions about their own healthcare. Information about the purpose, importance, benefits and risks 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 be appropriate to the patient’s cultural and socioeconomic understanding of health and illness 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 in which information is communicated in relation to potentially sensitive investigations or tests (eg. sexually transmissible infections or blood borne viruses). If working cross culturally, special care is needed to ensure there is a shared understanding between the health professional and the patient about the information provided.

The Australian Commission on Safety and Quality in Health Care (ACSQHC) encourages patients to actively discuss with their healthcare provider the purpose, importance, benefits and risks associated with their healthcare. The publication 10 tips for safer healthcare (available at www.racgp.org.au/safety) provides further detail.16 Health services may find it useful to refer patients to this information to help create an understanding of shared responsibility between the patient and the health service. Mutual understanding is an important component to the follow up of investigations that have taken place in order to achieve and maintain positive health outcomes.

The provision of information about medicines and medicine safety, including Consumer Medicines Information (CMI), may assist patients to make informed decisions about their medicines. Health professionals need to be confident that patients understand any reasons for changes to their medication and if a particular medication is not available, the implications of using alternative medication. Consumer Medicines Information provides an online version of leaflets produced by pharmaceutical companies for the general public and is available at www.nps.org.au/search_by_medicine_name. When it is not possible for a patient to continue using the same medication as they had been taking before incarceration, then it is important that the reasons for this be explained to the patient to encourage trust and compliance with a new medication regimen.

Should a patient decide not to follow the advice of a GP or other health professional after receiving sufficient information to make an informed decision about their care, their refusal and their awareness of its implications should be documented in the patient health record and an attempt made to provide alternative care.

Some people in prisons may be susceptible to self destructive or self harming behaviour (eg. over or under medicating or a hunger strike). Where a patient is known to be considering, or has embarked on self destructive or self harming behaviour, a GP may need to make judgments about the competence of the person to form an unimpaired and rational judgment concerning the consequences of such behaviour.

The cost of primary healthcare provided to patients in prisons is not charged to patients. To ensure there is certainty about this fact, it should be made clear to patients that they will not be charged for primary healthcare provided by the health service.

Where additional healthcare is required, it is the responsibility of other medical specialists and healthcare providers (eg. dentists) to give patients information about the cost of any treatment or investigations that will be charged to the patient. In the context of incarceration, these circumstances are relatively uncommon and usually arise where the care is elective.

Where elective investigations or treatments are required, the health service can help patients to make informed decisions about referrals to other specialists or healthcare providers by advising if there will be a cost involved. Costs may include charges beyond the scope of the health related investigations (eg. requiring a prison staff chaperone or associated transportation charges). It is suggested that health services seek information about these related additional costs to help patients make informed decisions about offsite medical treatment. Health service staff are not required to know the fee for a referred test or treatment, but they do need to indicate to patients that a fee may be incurred.

When medical or other clinical staff refer patients to institutions or services in which the staff member has a direct financial interest, the staff member needs to provide full disclosure of such interest to the patient. Medical staff are referred to the Medical Board of Australia publication Good medical practice: a code of conduct for doctors in Australia. Available at www.medicalboard.gov.au/codes-and-guidelines.aspx.

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