Patient information can encourage or limit choice

April 17, 2003

Patients have a right to information about their care. Good patient information should describe what will happen, explain why, and highlight possible choices with risks and benefits. Yet, a study in this week's BMJ finds that information is often poor and can limit a patient's ability to make choices about their care.

Researchers at the Royal Lancaster Infirmary analysed 51 leaflets about fasting before surgery from 267 anaesthetic departments in the United Kingdom. They identified three limiting factors:

Only 27 leaflets mentioned preoperative fasting, and only half of these included up to date evidence on fasting times. Such withholding of information limits patient choice because if evidence is not made available to patients they are unable to challenge unnecessarily prolonged fasts, write the authors.

The tone of language used in leaflets can also limit patient choice. Nine leaflets adopted a declarative or punitive tone, implying that the patient was a passive recipient of instructions rather than a partner in decisions. Eighteen leaflets were more explanatory, but some contained images and comparisons that may unintentionally disturb or threaten the reader.

Finally, the issue of safety may be used to deny patient choice, say the authors. Safety is a fluid concept; it changes over time and according to context. For instance, current evidence supports the safety of fasting times that were considered dangerous 20 years ago, and things may change again in the future.

Since this study was conducted, the Royal College of Anaesthetists have taken steps to raise the standard of patient information in this area, add the authors.

Acknowledging such uncertainties should foster a relationship of mutual confidence and respect and allow patients to understand why some choices might not be available to them, they conclude.
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BMJ

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