Article

Is Informed Consent a “Yes or No” Response? Enhancing the Shared Decision-Making Process for Persons with Aphasia

Harvard University, Cambridge, Massachusetts, United States
Topics in Stroke Rehabilitation (Impact Factor: 1.22). 02/2006; 13(4):42-6. DOI: 10.1310/tsr1304-42
Source: PubMed

ABSTRACT Respect for patient autonomy and the need to have a comprehensive discussion of the risks and benefits of a medical intervention are two important issues involved in the process of obtaining informed consent. In dealing with individuals with aphasia, there may be particular challenges in balancing these two ethical imperatives. Although decision-making capacity may be preserved with aphasia, the patients' ability to fully participate in a dialogue regarding a proposed medical intervention is frequently impaired. We propose a process of enhancing informed consent for persons with aphasia while continuing to respect and enhance patient autonomy and the exercise of decision making for these patients. The use of a patient-selected "helper" during the informed consent process can improve the quality of the informed consent, while reserving final decision-making authority for the patient.

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    • "Brady and Kirschner (1995) used case studies of individuals with aphasia to illustrate complex issues related to self-determination, capacity assessment, and ensuring a balance between stakeholder interests (i.e., family, patient, health care providers). Currently, there is a small body of literature comprising primarily case studies and discussion papers in which researchers advocate for a thorough understanding of communication disorders and an interactive, supportive capacity assessment process that can reveal DMC despite language and communication deficits (Brady & Kirschner, 1995; Brady Wagner, 2003; Carling-Rowland & Wahl, 2010; Davis & Ross, 2003; Diener & Bischof-Rosario, 2004; Ferguson et al., 2003, 2010; Finestone & Blackmer, 2007; Mackenzie, Lincoln, & Newby, 2008; Pachet et al., 2012; Stein & Brady Wagner, 2006). Although SLPs may be asked to assist with assessments of DMC, little is known about the nature of their involvement in such assessments, nor about their perspectives on DMC assessments for persons with aphasia (PWA). "
    Aphasiology 08/2015; DOI:10.1080/02687038.2015.1065468 · 1.73 Impact Factor
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    • "In order to facilitate the implementation of elements of PCC in the acute setting for people with aphasia, enrichment of the Downloaded by [La Trobe University] at 15:35 03 April 2013 communicative interaction is required. This may be achieved through the involvement of a patient-selected " helper, " or the implementation of communication strategies which facilitate the participation of people with aphasia (Stein & Brady Wagner, 2006). Communication strategies which may facilitate this include accessible healthcare information (Parr, Pound, & Hewitt, 2006; Rose, Worrall, Hickson, & Hoffmann, 2010), supported conversation techniques (Kagan, 1998), decision aids (Hoffmann & Tooth, 2010; Trevena, Baratt, & McCaffery, 2008), and Talking Mats ® (Bornman & Murphy, 2006). "
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