Informed consent among chronically ill elderly: Assessing its (in)adequacy and predictors

Abstract

Physicians are legally and ethically required to obtain informed consent from patients prior to providing medical care. However, the chronically ill elderly may poorly understand the facts that are needed for them to make informed choices, and they also may wish to avoid discussing potentially discouraging information. Interviews of 142 elderly hemodialysis patients were conducted to determine whether informed consent for performing dialysis had been obtained and to explore potential causes of inadequate informed consent. As predicted, most patients lacked information needed to render fully informed consent. However, when we examined potential causes for the very low levels of knowledge reported by patients, we found that patients’ education level, cognitive capacity, and willingness to discuss medical contingencies were stronger predictors of informed consent than were the communicative practices of doctors. Neither doctors’ willingness to promptly disclose the need for dialysis nor their willingness to discuss forgoing dialysis were related to any of the patient characteristics. Results suggest that obtaining fully informed consent for chronically ill elderly requires both a modification of doctors’ communication practices and greater adaptation to the cognitive capacity, education, and communication practices of the patient.