Informed Decision Making Trumps Informed Consent for Medical Imaging with Ionizing Radiation

Department of Diagnostic Radiology, Yale University School of Medicine, 789 Howard Ave, New Haven, CT 06520, USA.
Radiology (Impact Factor: 6.87). 01/2012; 262(1):11-4. DOI: 10.1148/radiol.11111421
Source: PubMed
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    • "The precision of the varying legal definitions used in different territories may not always be intended. A more detailed discussion of the legal issues surrounding the information and consent is required (Brink et al., 2012; Semelka et al., 2012). "
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    ABSTRACT: Chapter Outline 7.1 Introduction 107 7.2 Ethics in Medical Radiology 109 7.2.1 Core Principles in Medical Ethics 109 7.2.2 A Basic Analysis 111 7.3 Medical, Social, and Legal Context for Radiology 114 7.3.1 Overutilization and Health Economics 116 7.4 Risk, Uncertainty,Communication, and Skeptical Doctors 116 7.5 Justification Issues 118 7.5.1 Awareness 119 7.5.2 Appropriateness and Referral Guidelines 120 7.5.3 Audit (Clinical) 121 7.5.4 Some Reasons for Failure of Justification 121 7.6 Some Special Concerns 121 7.6.1 Nonmedical Exposures 121 7.6.2 Regulatory Framework 122 7.6.3 Some Pregnancy Issues 123 7.7 Conclusions 124
    Social and Ethical Aspects of Radiation Risk Management, First edited by D. Oughton & S. Ove Hansson, 09/2013: chapter 7: pages 105-130; Elsevier Science., ISBN: 9780080450155
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    • "Some authors argue that informed consent cannot account for stochastic risk uncertainties [29]. In this scenario, patients must be fully informed of what is known and what is unknown, but it is not advisable to establish a contract between a patient and the physician that reflects uncertainty [29]. "
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    ABSTRACT: Inappropriate ionising medical imaging has been escalating in the last decades. This trend leads to potential damage to health and has been associated to bioethical and legal issues of patient autonomy. While the doctrine underlines the importance of using informed consent to improve patient autonomy and physician-patient communication, some researchers have argued that it often falls short of this aim. There are basically two different informed consent practices. The first - the so-called "event-based model" - regards informed consent as a passive signature of a standard unreadable template, performed only once in each medical pathway. The second - the so-called "process-based model" - integrates information into the continuing dialogue between physician and patient, vital for diagnosis and treatment. Current medical behaviour often embraces the event-based model, which is considered ineffective and contributes to inappropriateness. We sought, in this review, to analyse from juridical and communication standpoints whether process-based informed consent can deal with scientific uncertainties in radiological decision-making. The informed consent is still a distinctive process in defence of both patients' and physicians' health and dignity in rule-of-law states and consequently in curtailing the abuse of ionising medical radiation. • Inappropriate ionising medical imaging is widespread and increasing worldwide. • This trend leads to noteworthy damage to health and is linked to the issue of patient autonomy. • Some authors have argued that informed consent often falls short of improving patient autonomy. • Process-based informed consent can deal with scientific uncertainties to contrast inappropriateness. • Informed consent is still a distinctive process in defence of both patients and physicians.
    Insights into Imaging 08/2013; 4(5). DOI:10.1007/s13244-013-0272-6
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    • "In today's medico-legal world, patients are informed and consented regarding a wide variety of hospital practices [3] [4]. At present, patients are not routinely consented or given detailed information about their CT scan prior to attending their appointment. "
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    ABSTRACT: AIM: CT scanning is a widely utilised effective diagnostic tool. We aimed to establish whether patients are adequately informed prior to undergoing CT investigations. Methods: All adult patients with mental capacity attending the de-partment for a CT study over a week period were invited to fill out a brief questionnaire prior to their scan. Results: 57 patients returned completed questionnaires. Overall 23% of patients were unsure or incorrect about the type of scan scheduled. Of patients attending with a new condition, 46% of them did not know their provisional diagnosis. Only 32 % of patients had insight into how a CT scan worked. This was taken to mean that the patient had included some refer-ence to either x-rays, radiation or cross sectional imaging. Only 23% of patients were aware of potential complications of CT scans. Conclusion: Although written consent prior to CT scan is probably a step too far in providing patients with relevant risks/benefits of their investigation, we propose all patients undergoing CT have prior access to a written information sheet should they wish to be further informed regarding their procedure.
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