Matiasek Jennifer, Wynia Matthew K
Institute for Ethics, American Medical Association, Chicago, USA.
Jt Comm J Qual Patient Saf. 2008 Mar;34(3):127-37. doi: 10.1016/s1553-7250(08)34015-x.
Hospitals struggle to make informed consent processes understandable for patients. Amid "promising practices" for patient-centered communication, there is debate over how to handle consent processes for patients with limited literacy, health literacy, or English proficiency.
In 2005, the American Medical Association's Ethical Force Program and the American Hospital Association's Health Research and Educational Trust conducted eight site visits to determine how hospitals use patient-centered communication to improve health care.
Each of the eight hospitals noted a number of problems in the traditional informed consent process, sparking a broad set of efforts to improve. Disagreements about how to do so often focused on whether to attempt simplification and translation of informed consent documents. Specifically, hospital leaders held widely divergent views on legal and accreditation requirements for these forms. However, several other promising practices met with widespread approval.
Overall, informed consent in the eight hospitals was becoming more patient centered and integrated. The significant variation across states makes it difficult to provide overarching policy guidance on the informed consent process. Greater regulatory clarity is needed so that policies and practices can be more closely aligned with the ethical foundations of informed consent.
医院努力让患者理解知情同意流程。在以患者为中心的沟通的“良好实践”中，对于如何处理识字能力、健康素养或英语水平有限的患者的同意流程存在争议。
2005年，美国医学协会的道德力量项目和美国医院协会的健康研究与教育信托基金进行了八次实地考察，以确定医院如何利用以患者为中心的沟通来改善医疗保健。
八家医院中的每一家都指出了传统知情同意流程中的一些问题，引发了一系列广泛的改进努力。关于如何改进的分歧通常集中在是否尝试简化和翻译知情同意文件上。具体而言，医院领导对这些表格的法律和认证要求持有广泛不同的观点。然而，其他一些有前景的做法得到了广泛认可。
总体而言，八家医院的知情同意正变得更加以患者为中心且更加综合。各州之间的显著差异使得难以就知情同意流程提供总体政策指导。需要更大的监管清晰度，以便政策和实践能够更紧密地与知情同意的伦理基础保持一致。
