緩和ケアと医学

抽象的な

Prognosis: Important Information when obtaining Informed Consent

Vincent Maida and Paula Chidwick

Informed consent must be obtained in advance of allpersonal care, investigations, and treatments. For informed consent to be complete and valid, the person giving consent must be capable of making decisions, act voluntarily, and be provided with all necessary information to arrive at a decision that will be in the best interests of the patient. Information sharing has generally focused on available options, risks and benefits of a given intervention, and implications of foregoing the intervention. However, it is difficult to interpret such information without a discussion about the clinical context, natural history of disease, and its associated prognosis.Prognostication, consisting of both the computation (formulation) and disclosure of prognosis, is a key facilitator and enabler for the delivery of truly patient-centered care. Studies have demonstrated that despite patients desiring prognostic information, significant gaps in communication occur between physicians and patients. In a majority of cases of patients with advanced illness there is evidence that disclosure of prognosis has not occurred, thus raising the question as to whether the “informed consent” in this setting is ethically and legally valid.