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  • Improving the rate of documented patient consent for systemic therapy at a tertiary cancer care centre: A quality improvement project from the Sunshine Coast University Hospital

    Author(s)
    Jakobsson, Haakan
    Wood, Samuel
    Fletcher, James
    Azer, Mary
    Francesconi, Alessandra
    Houston, Kathleen
    Long, Jeremy
    Manders, Peter
    Morris, Michelle
    Wilson, Jennifer
    Chan, Bryan A
    Griffith University Author(s)
    Chan, Bryan
    Jakobsson, Haakan
    Year published
    2018
    Metadata
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    Abstract
    Background: Consent to treatment is a critical part of ethical medical practice that values patient autonomy. Chemotherapy and other systemic therapies pose additional challenges with complex discussions on risks, benefits and patient preferences. Documentation of the consent process and outcome is an important quality and medicolegal requirement. Aims: To improve the proportion of new patients with documented consent for systemic therapy at the Sunshine Coast University Hospital Oncology Department over a 12‐month period. Methods: A multidisciplinary team of quality improvement officers, physicians, nurses, pharmacists ...
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    Background: Consent to treatment is a critical part of ethical medical practice that values patient autonomy. Chemotherapy and other systemic therapies pose additional challenges with complex discussions on risks, benefits and patient preferences. Documentation of the consent process and outcome is an important quality and medicolegal requirement. Aims: To improve the proportion of new patients with documented consent for systemic therapy at the Sunshine Coast University Hospital Oncology Department over a 12‐month period. Methods: A multidisciplinary team of quality improvement officers, physicians, nurses, pharmacists and administration staff investigated the root causes for low rates of documented consent. Quality improvement methodology including process flow charts, cause‐and‐effect analyses and Pareto charts were constructed to identify the key modifiable factors. After an initial run‐in period (Apr to Jul 2017), Plan‐Do‐Study‐Act (PDSA) interventions were implemented (August 2017 to July 2018) involving physician and nurse education, improved access to forms and modifications in clinic processes. Evidence of consent in the electronic medical record was documented via continuous tally sheets. The Chi‐squared statistic was used to compare the difference in proportions of patients with consent in pre‐ versus post‐intervention cohorts. Results: There were 546 eligible new patients in the study period. The post‐intervention group were more likely to have documented consent than the pre‐intervention group (χ2 = 15.45, P < 0.001). In the pre‐intervention group, only 54.2% had documented consent, compared to 73.1% in the post‐intervention group, an improvement of 18.9% (95% CI 9.0% to 28.8%). Modifying clinic processes had the most impact with the most recent monthly consent rates now at 100%. Conclusions: Rates of documented consent can be increased by systematic quality improvement methodology. Involvement of key stakeholders in the multidisciplinary team is critical for success. Ongoing efforts to monitor and continually improve the consent process are important for patient autonomy as well as ethical and medicolegal obligations.
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    Conference Title
    Asia-Pacific Journal of Clinical Oncology
    Volume
    14
    Issue
    S7
    DOI
    https://doi.org/10.1111/ajco.13089
    Subject
    Oncology and carcinogenesis
    Science & Technology
    Life Sciences & Biomedicine
    Publication URI
    http://hdl.handle.net/10072/393461
    Collection
    • Conference outputs

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