Patient autonomy [Neurosurgery Wiki]

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====== Patient autonomy ======

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Patient [[autonomy]] is a foundational principle in healthcare [[ethics]] that emphasizes the right of patients to make informed decisions about their medical [[care]]. It recognizes the patient's capacity to understand, deliberate, and choose their path in their health journey based on personal values, beliefs, and preferences. Autonomy is central to patient-centered care and supports several key aspects:

1. **[[Informed Consent]]**: Patients should have access to all relevant information about potential diagnoses, treatment options, risks, benefits, and alternatives. Informed consent ensures that patients can make knowledgeable choices about their care.

2. **[[Decision-Making]] Rights**: Patients have the right to accept or decline treatments, even if their choice goes against medical recommendations. This includes the right to refuse treatment, seek second opinions, and prioritize comfort over aggressive intervention.

3. **Respect for Personal Beliefs and Values**: Autonomy acknowledges that patients may have unique cultural, religious, or personal beliefs influencing their medical decisions. [[Healthcare provider]]s must respect these beliefs while guiding patients through the medical process.

4. **[[Privacy]] and [[Confidentiality]]**: Patient autonomy includes the right to confidentiality regarding health information. Ensuring privacy empowers patients to feel secure in sharing their information, which is crucial for effective care.

5. **End-of-Life Decisions**: Autonomy is particularly important in end-of-life care, where patients may choose how they want to spend their final days, including preferences for life-sustaining measures, palliative care, or do-not-resuscitate orders.

6. **Shared Decision-Making**: Autonomy supports collaborative communication between patients and [[provider]]s. Shared decision-making allows patients to understand their options and for providers to respect patient input in choosing a suitable treatment path.

In practice, promoting patient autonomy requires effective communication, a commitment to education, and respect for the patient’s right to self-determination. Balancing autonomy with the provider’s duty to act in the patient's best interest, however, can sometimes be challenging—particularly in situations where a patient’s choices might lead to adverse outcomes. Ultimately, respecting patient autonomy honors the dignity and individuality of each patient, fostering trust and alignment with their health goals.
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The [[informed consent]] process in neurosurgery aims to support patient autonomy and provide comprehensive [[information]] for [[decision-making]]. However, gaps in [[communication]] and understanding between patients and surgeons persist, that need to be addressed. 

A systematic review examined the interventions and strategies to enhance the process of consent in neurosurgery.

A comprehensive search of databases and relevant sources to identify relevant studies for inclusion. A systematic review of prospective and retrospective studies that assess the effect of interventions that improve the consent process. Data collection and analysis involved independent [[reviewer]]s assessing eligibility, study quality, and risk of bias. Findings from the included studies were used to write the review.

The review identified seven studies that notably revealed an educational and interactive consent process involving strategies like booklets, videos, multiple interviews, and interactive websites that showed improvements in patient knowledge. Recall of risks decreased over time, and factors like age, education, and timing of consent influenced recall.

Authors’ conclusions: To maximize informed consent, neurosurgeons should consider various strategies. Tailoring communication based on patients' health literacy and treatment knowledge, involving their support system, and using a bullet-point consent form is essential. Utilizing multiple modalities like verbal, static, and dynamic visuals improves information retention. Creative and memorable visual aids enhance comprehension. Allowing time for questions and a team approach is superior
((Elmahdi A, Smith D. Interventions and strategies for enhancing the consent process in neurosurgery. A systematic review of the literature. Br J Neurosurg. 2024 Nov 3:1-6. doi: 10.1080/02688697.2024.2421833. Epub ahead of print. PMID: 39491339.)).