autonomy, and is the formal application of clients’ rights to make decisions about their health care (Lee, 2016). Autonomy, or self-rule, is founded on the principle of respect, which holds that individuals have the right to make their own choices and develop their own life plan (Lee, 2016). The principle of client autonomy is the basis of informed so the practitioner must discuss and explain all proposed treatment, determine client preference, encourage them to make decisions in the care plan, and document the consent process in the client record. The client’s medical history and treatment, for physical and mental conditions, must be part of the informed consent and the client must disclose to the practitioner all chronic or acute conditions, injuries, disabilities, medications, and contraindications to massage and bodywork. As the services progress, the consent agreement should include the stipulation that the client must inform the practitioner if there are changes in their physical or mental condition changes. The practitioner must revisit the informed consent agreement if there are changes in the plan of service to allow the client to make informed decisions about their ongoing care. Informed consent for massage therapy typically includes a statement explaining the role of massage therapy in pain and stress reduction, or other specified purposes, and the limitations of treatment as follows: ● Massage therapy does not take the place of medical examinations, care, or treatment. ● The therapist is not a doctor and does not diagnose medical conditions or prescribe treatment or medication. ● Clients should continue to consult their primary caregivers or other specialists for ongoing health care for medical conditions. ● Clients should consult their primary caregiver to review healthcare recommendations before making significant changes in their health, exercise, diet, or massage regimen. (Lee, 2016) Beyond the ethical obligation of massage therapists to ensure informed consent and client autonomy, legislation in all states requires informed consent though requirements vary among states. State guidelines require clients to be informed of the following components: ● The objective to be met and proposed services to address the client’s request for services. ● Explanation of the modality to be provided, benefits and risks, possible alternative methods, including the possible outcome of continuing with no treatment. A description of the procedure must provide details including any unorthodox or novel components. It is important that no procedure should be included that is beyond the level of practitioner competency. ● Informed consent must identify the practitioners delivering the plan ● Failure to obtain adequate informed consent is an ethics violation, and exposes healthcare professionals to liability for negligence or battery, and constitutes professional and/or medical malpractice (Lee, 2016). While informed consent is a required and widely used practice, recent research findings show that even when clear and simple information on procedures and outcomes is provided, clients may not truly be informed (Eyal, 2012). Studies by the United States (U.S.) government suggest many clients do not read consent forms before signing, do not ask for clarification, and that only 35 percent of Americans understand commonly used medical terms (Garcia, 2014). Fourteen percent of U.S. citizens have limited reading ability, placing them at increased risk for medical errors, e.g., due to problems reading medication bottles, appointment slips, self-care instructions, health educational brochures, and consent forms (Garcia, 2014). Several methods to improve informed consent have been suggested, and the following outlines best practices for
increasing comprehension of informational materials and informed consent forms: ● All materials must be presented at each client’s reading level. ● All materials must be in the client’s preferred language. ● Written health-care materials, such as consent forms, should be written with simple sentence structure and vocabulary, making it easier to comprehend. ● The materials’ format may include visual clues, white spaces, and less information on the page to encourage thorough reading. Many poor readers will not attempt a full, single- spaced form if they feel will take too much time and effort to read. ● Use a structure that promotes the main idea and supporting details in bullet or list form rather than using long, complicated paragraphs. ● Always provide materials in a format to accommodate client disabilities ● Ask if the client needs an interpreter or if he or she prefers to bring a family member or friend to assist in the discussion process as long as confidentiality can be maintained. ● Provide written information to clients regarding purpose of treatment, treatments methods, and other information to support discussions leading to informed consent decisions. The client can refer back to the information to support comprehension. Some practitioners provide clients with written information and consent forms weeks before the initial session to give them time to review the material. ● Always encourage questions, and give adequate time for discussion. ● Access comprehension by informal methods such as observing facial expression, body language, tone, rate or frequency of speech. ● Watch for emotional responses that indicate stress, fear, frustration, or anger. Respond with strategies to give clarification and assistance to address these reactions for a positive outcome. ● Review all available information on the client prior to the first session to be as informed as possible to address clients’ unique needs. ● Be aware of cultural differences that may influence effective communication with clients. Key principles of informed consent include the following: ● Informed consent is always specific to the individual patient, the clinical situation, and the recommended plan of care or recommended treatment or procedure. ● Practitioners provide the information that a “reasonable person” in similar circumstances would want to know when making the treatment decision. Explain why the practitioner believes that recommended treatments or procedures will be more beneficial than alternatives in the context of the patient’s diagnosis. ● Consent for multiple treatments: separate consent is always required for every episode of repeated treatment. When the plan of care for a given diagnosis involves repeated treatments or procedures, practitioners should ensure that patients understand that they are consenting to multiple episodes of treatment. Separate consent is not required for each individual session. ● If a patient’s condition changes, and a change in the care plan is indicated, the practitioner must explain to the patient how the situation has changed, establish new goals of care to address the new situation, recommend a new plan of care, and obtain informed consent for the new plan or for specific treatment or procedure recommended. ● Notification versus consent: informed consent differs from “notification,” which is general information relevant to clients’ participation in health care. Patients must be notified that their records will be used for purposes of routine healthcare operations. Likewise, patients should be notified that their information may be used for quality improvement purposes to enable the organization to fulfill its obligation to
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