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. • Assess comprehension by informal methods such as observing facial expression, body language, tone, and 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 include the following (Sohnen-Moe, 2022): • Informed consent is always specific : The goal of the informed consent process is to ensure that clients have an opportunity to be informed participants in decisions about their healthcare. To achieve that goal, practitioners must explain the patient’s condition and inform the patient about treatment options and alternatives, including the risks and benefits of each, providing the information that a “reasonable person” in similar circumstances would want to know when making the treatment decision. A key element of the process is that practitioners explain why they believe recommended treatments or procedures will be more beneficial than alternatives in the context of the patient’s diagnosis. Thus, informed consent is always specific: to the individual patient, the clinical situation, and the recommended plan of care or recommended treatment(s) or procedure(s). • Consent for multiple treatments : However, to say that consent is always specific is not the same as saying that 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 episode. If a patient’s condition changes enough to warrant a change in the care plan, the practitioner must explain to the patient how the situation has changed, establish goals of care in light of the new situation, recommend a new plan of care, and obtain informed consent for the new plan or for specific treatment(s) or procedure(s) now recommended. • Notification versus consent : Informed consent also differs from “notification,” that is, providing general information relevant to clients’ participation in healthcare. Similarly, patients entering a healthcare facility 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 monitor the quality of care it delivers and to carry out quality improvement activities for the benefit of all clients. Notification informs clients not only about their rights but also about
asserting that the client has informed the practitioner about all known physical or medical conditions and current medications and will inform the practitioner if any of these conditions change (Sohnen-Moe, 2022). Informed consent in massage therapy typically includes a statement explaining the role of massage therapy in pain and stress reduction, other specified purposes, and its limitations (Sohnen-Moe, 2022). For example: • 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 medication. • Clients should continue to consult their primary caregivers or other specialists for ongoing healthcare and medical conditions. • Clients should consult their primary caregiver to review healthcare recommendations before making significant changes in their health and exercise regimen or diet. In addition to being an ethical obligation of caregivers, including therapists, AMBP requires that clients be informed of all important aspects of a treatment and/or procedure, although the details of these laws and statutes differ greatly. General guidelines require clients to be informed of the nature of their condition and the proposed treatment or procedure, its purpose, risks and benefits and their probability, risks and benefits of alternatives, and risks and benefits of not receiving the treatment. Failure to obtain adequate informed consent renders a healthcare professional liable for negligence or battery and constitutes medical malpractice (AMBP, 2022). While informed consent is a well-established practice, it often fails to meet its stated purpose. Recent research findings strongly suggest that procedures to obtain informed consent may not adequately promote the patient’s comprehension of the information provided, rendering the consent not truly informed. Studies suggest that a majority of patients do not read a consent form before signing it, and less than half of the U.S. population understands commonly used medical terms. Additionally, clients with limited reading ability are at increased risk for medical errors, due to problems reading medication bottles, appointment slips, self-care instructions, and health education brochures. These clients are also likely to have trouble reading materials intended to aid in obtaining informed consent (Sohnen- Moe, 2022). 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 (Sohnen-Moe, 2022): • 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 it 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
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