Consent

FAQs: Consent

• As a PT, I've often heard that consent is a conversation, not a form. What exactly does that mean?

• What is a lock box?

  A “lock-box” is not a thing but rather a concept or term used to describe the right of patients to withhold or withdraw their consent to the collection, use or disclosure of their personal health information. Individuals may expressly instruct you to not use or disclose their personal health information for health care purposes.

  They could tell you to:

  • not collect, use or disclose a particular item of personal health information, such as a specific diagnosis, for health care purposes, 
  • not to collect, use or disclose the contents of their entire record of personal health information, or
  • not to use or disclose their personal health information to a particular individual or group.

  A patient cannot stop you from recording personal health information that is required by law or by College Standards. But once a patient locks personal health information, you cannot use or disclose the information, unless the individual provides express consent, or unless the law allows you to disclose the locked personal health information (for example, in an emergency).

  If you later need to share information about the patient with another health care provider, and you don't have the patient's consent to disclose all the personal health information you feel is necessary, you must notify the receiving health care provider of that fact (i.e., that there is information being withheld at the patient's request - but not the information itself). The receiving provider would then be able to explore the matter of the locked personal health information with the patient and seek their express consent to access the locked information. 
  
  Here is a link to a Fact Sheet put out by the Office of the Information and Privacy Commissioner of Ontario

  
  

• What is the age of consent for physiotherapy treatment?

  The Health Care Consent Act does not specify a particular age that a patient must be to give or refuse consent to treatment. This means that children do not need to be at least 16 or 18 to provide their consent. This is in contrast to the requirement that a person must be at least 16 years old to act as a substitute decision maker for an incapable patient.
  
  Likewise, there is no particular age at which a person loses the right to make their own health decisions.
  
  What is important is whether the health practitioner is of the opinion that a patient, even if younger than 16 or more advanced in age, is mentally CAPABLE to provide the consent.
  

• What information do I need to provide a patient to be confident I get their informed consent for an assessment or treatment plan?

  You should give the patient all the information they need to be fully informed about the proposed assessment or treatment.

  You will want to discuss the following and personalize to the patient's condition, needs and values:

  • What you propose to do 
  • How they will benefit
  • Any potential and material risks or side effects
  • Any other viable options
  • The consequences of not receiving treatment 
  • How often they will need to attend and the expected length of course of treatment
  • The costs involved

  Be sure to answer any questions they may have as well. 

• What evidence do I need from a patient to show consent for physiotherapy care?

  Patients can give their consent expressly (either verbally or in writing) or it can be implied (by words, behaviour or circumstances).

  Having a patient sign a form does not ensure they understand. You need to take time to provide all the information they need to make a decision and answer any questions they may have.
  
  Check in with them often. Even if a patient initially consents, they can refuse treatment or change their mind and withdraw their consent at any time. 

  Document in the patient's chart that consent was obtained. Include information such as: the information discussed, who was involved in the discussion, and the questions asked and answered. If you do have the patient sign a written consent form, be sure to include it in the patient's chart.

• Do I need to get consent for the involvement of a student in a patient's care?

  Yes! The supervising physiotherapist needs to get consent to involve others in the patient’s care. This includes students, physiotherapist assistants and volunteers. You should discuss your role and responsibilities with the patient as well as those of the student, PTA or volunteer. 

  You can have the student introduce themselves to the patient and explain their role as long as the patient understands who the supervising PT is, and that they are available to answer questions the patient might have.

• If I am providing home-care to a patient who has Alzheimer's Disease, do I need to document the patient's consent every time I treat?

  A patient who has Alzheimer’s Disease can be in an early or a late phase of the disease. The PT needs to determine what part of the physiotherapy program the patient can understand, including the benefits, risks and alternatives of treatment (including if no treatment is provided). If the PT believes the patient is unable to understand the proposed physiotherapy plan the PT defers to the Substitute Decision Maker (SDM).  
  
  The SDM can consent to a plan of care that includes more than one session. 
  
  You should keep a record of the physiotherapy program that was discussed and consented to by either the patient or the SDM. 
  
  Providing and Refusing Care Standard
  
  Consent Resource

• How does a physiotherapist know if a patient is capable of making health care decisions?

  There are three types of capacity – for treatment, for discharge to a long-term care facility and for finances. Physiotherapists can assess capacity for proposed physiotherapy treatment. 
  
  Generally, a person is presumed to be capable to make decisions about treatment unless reasonable grounds to suspect incapacity exist. 
  
  The patient must be able to understand:
  
  • The information needed to make a decision about their treatment.
  
  • The reasonably possible consequences of giving consent to the treatment or refusing to consent to the treatment.           
  
  Let’s look at a quick example: 
  
  • 86-year-old patient with a diagnosis of dementia is day one post hip Arthroplasty.
  
  • The health care team would like the patient to begin getting up from a chair to stand.
  
  • In the morning the nurse says that the patient seems “confused.”
  
  How would you assess the patient’s capacity to consent to physiotherapy and to stand with a walker? 
  
  • Explain to the patient that you would like to support them to stand and how this will benefit activating the hip muscles after surgery.
  
  • Demonstrate to the patient how you would help them to stand and show them how to hold the walker.
  
  • Ask the patient if they are comfortable to try to stand.
  
  • Let the patient know that they can stop at any time.
  
  Observe how the patient responds. Watch their body language and facial expressions and look for other indications that they are willing to try and stand. Consider their understanding of the treatment. 
  
  If the patient reaches for the walker and says “Yes, I would like to stand up. I will stop if I’m too uncomfortable,” then you might decide that you have enough information to suggest that the patient is capable of making decisions about treatment.
  
  Remember, the decision will always be case by case, and a patient’s capacity may change throughout the day. You should continuously re-evaluate capacity.
  
  The patient's autonomy to make decisions about their own healthcare should be respected where possible. Ultimately, the PT must decide or determine a patient’s capacity for the proposed treatment.