Clinicians’ consent law knowledge: The case for education
Keywords:aging, advance care planning, advance directives, decision-making, medical education, legislation
AbstractIntroduction: The short-term objectives of this study were to investigate clinicians’ confidence with, and knowledge of, consent laws, their behaviour regarding familiarisation with patients’ advance care plans and the potential benefit of brief education. Education covered patients’ rights to refuse treatment, including via advance directive, and the legislated hierarchy of decision-making authority.Methods: Throughout 2018, all clinicians at one Queensland Hospital and Health Service were invited to attend a 1-hour legal education session. The study used a crosssectional survey to measure clinicians’ knowledge before and after education. Responses from 316 pre- and 319 post-education questionnaires were analysed.Results: A 1-hour legal education session improved clinicians’ understanding of legislated consent hierarchy and patients’ rights. Pre education, 4.1% of participants correctly identified the lawful consent hierarchy, rising to 65.5% after education. Accuracy increased significantly after education; however, substantial errors persisted.Conclusions: The potential benefit of education to increase multidisciplinary clinicians’ legal knowledge was supported. Education can ensure that clinicians are made aware of patients’ rights and the potential complexity of lawful substitute decision making.
Australian Commission on Safety and Quality in Health Care. (2014). The National Safety and Quality Health Service (NSQHS) standards. In Comprehensive Care Standard. Author.
Burkle, C. M., Mueller, P. S., Swetz, K. M., Hook, C. C., & Keegan, M. T. (2012). Physician perspectives and compliance with patient advance directives: The role external factors play on physician decision making. BMC Medical Ethics, 13, Article 31. https://doi.org/10.1186/1472-6939-13-31
Cartwright, C., Montgomery, J., Rhee, J., Zwar, N., & Banbury, A. (2014). Medical practitioners' knowledge and self‐reported practices of substitute decision making and implementation of advance care plans. Internal Medicine Journal, 44(3), 234–239. https://doi.org/10.1111/imj.12354
Cartwright, C. M., White, B. P., Willmott, L., Williams, G., & Parker, M. H. (2016). Palliative care and other physicians' knowledge, attitudes and practice relating to the law on withholding/withdrawing life-sustaining treatment: Survey results. Palliative Medicine, 30(2), 171–179.
Corke, C., Milnes, S., Orford, N., Henry, M. J., Foss, C., & Porter, D. (2009). The influence of medical enduring power of attorney and advance directives on decision-making by Australian intensive care doctors. Critical Care and Resuscitation, 11(2), 122–128. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=mdc&AN=19485876&site=ehost-live
Parker, M., Willmott, L., White, B., Williams, G., & Cartwright, C. (2015). Medical education and law: Withholding/withdrawing treatment from adults without capacity. Internal Medicine Journal, 45(6), 634–640. https://doi.org/10.1111/imj.12759
Royal Australian College of General Practitioners. (2012). Position statement: Advance care planning should be incorporated into routine general practice. https://www.racgp.org.au/advocacy/position-statements/view-all-position-statements/clinical-and-practice-management/advance-care-planning
Sellars, M., Detering, K. M., & Silvester, W. J. (2015). Current advance care planning practice in the Australian community: An online survey of home care package case managers and service managers. BMC Palliative Care, 14(1), Article 15. https://doi.org/10.1186/s12904-015-0018-y
White, B., Tilse, C., Wilson, J., Rosenman, L., Strub, T., Feeney, R., & Silvester, W. (2014). Prevalence and predictors of advance directives in Australia. Internal Medicine Journal, 44(10), 975–980. https://doi.org/10.1111/imj.12549
White, B., Willmott, L., Cartwright, C., Parker, M. H., & Williams, G. (2015). Doctors' knowledge of the law on withholding and withdrawing life-sustaining medical treatment. Medical Journal of Australia, 202(2), 77. https://doi.org/10.5694/mja14.01363
White, B., Willmott, L., Cartwright, C., Parker, M., & Williams, G. (2016). The knowledge and practice of doctors in relation to the law that governs withholding and withdrawing life-sustaining treatment from adults who lack capacity. Journal of Law and Medicine, 24, 356–370.
White, B. P., Willmott, L., Cartwright, C., Parker, M., Williams, G., & Davis, J. (2017). Comparing doctors' legal compliance across three Australian states for decisions whether to withhold or withdraw life-sustaining medical treatment: Does different law lead to different decisions? BMC Palliative Care, 16(1), Article 63. https://doi.org/10.1186/s12904-017-0249-1
White, B. P., Willmott, L., Williams, G., Cartwright, C., & Parker, M. (2017). The role of law in decisions to withhold and withdraw life-sustaining treatment from adults who lack capacity: A cross-sectional study. Journal of Medical Ethics, 43(5), 327–333. https://doi.org/10.1136/medethics-2016-103543
White, B., Willmott, L., Yates, P., Shih-Ning, T., & Neller, P. (2019). End of life law for clincians. https://end-of-life.qut.edu.au/
Willmott, L., White, B., Close, E., Gallois, C., Malcolm, P., Graves, N., Winch, S., Callaway, L., & Shepherd, N. (2016). Futility and the law: Knowledge, practice and attitudes of doctors in end of life care. QUT Law Review, 16(1), 55–75. https://doi.org/10.5204/qutlr.v16i1.622
Willmott, L., White, B., Gallois, C., Parker, M., Graves, N., Winch, S., Callaway, L., Shepherd, N., & Close, E. (2016). Reasons doctors provide futile treatment at the end of life: A qualitative study. Journal of Medical Ethics, 42(8), 496–503. https://doi.org/10.1136/medethics-2016-103370
Willmott, L., White, B., Parker, M., Cartwright, C., & Williams, G. (2016). Is there a role for law in medical practice when withholding and withdrawing life-sustaining medical treatment? Empirical findings on attitudes of doctors. Journal of Law and Medicine, 24(2), 342–355. https://eprints.qut.edu.au/102166/9/102166.pdf
Willmott, L., White, B., Tilse, C., & Wilson, J. (2013). Advance health directives: Competing perceptions, intentions and use by patients and doctors in Queensland. QUT Law Review, 13(1), 30–51. https://doi.org/10.5204/qutlr.v13i1.532
Wong, R. E., Weiland, T. J., & Jelinek, G. A. (2012). Emergency clinicians' attitudes and decisions in patient scenarios involving advance directives. Emergency Medicine Journal, 29(9), 720–724. https://doi.org/10.1136/emermed-2011-200287
On acceptance for publication in FoHPE the copyright of the manuscript is signed over to ANZAHPE, the publisher of FoHPE.
Any reproduction of material published in FoHPE must have the express permission of the publisher.
ANZAHPE has licence agreements with third parties allowing world wide access to material published in FoHPE and these require the honouring of copyright.
This policy is under review by the ANZAHPE Committee of Management.