Consent Forms for ECT: Study from Australia
Out on PubMed, from investigators in Australia, is this study:
Quality of written informed consent forms for electroconvulsive therapy in Australia: a comparative analysis.
Objectives: We compared the quality of the written informed consent forms for electroconvulsive therapy (ECT) in Australian jurisdictions.
Method: For this comparative audit-type study, a checklist was developed to compare informed consent forms from different jurisdictions. The main information sources for consent forms were government health department websites and Google. The directors of clinical services were contacted if a consent form was not available through a web source.
Results: Majority of the informed consent forms covered information about ECT, general anaesthesia and alternative treatments, supports available for decision making, and a reference to the right to withdraw consent. Missing information affected information areas such as likely outcome if no ECT, lack of guaranteed response and cultural and linguistic supports.
Conclusions: A standardised consent form that can be used across all jurisdictions can help improve the ECT practice.
Keywords: ECT; capacity; consent; evidence; form.
And from the text:
In conclusion, although there are limitations to any audit type studies, our findings shows that the written ECT consent forms are mostly comparable in their content across Australian jurisdictions. Further research is needed on this topic by including private sector and other countries. Another area to explore is how often consumers receive a copy of the signed informed consent form. A consent form is not a replacement for clinical assessment and documentation by psychiatrists, but a comprehensive ECT consent form can aid consumers to revise ECT-related information during the course of treatment. Also, a consistent and standard approach can improve the practice of ECT.
This survey audit of ECT consent forms from Australia serves to focus our attention on the ECT consent process. The details of practice in Australia may be of limited interest to practitioners in other countries, but the main concepts are all applicable.
While critics of ECT contend that consent is often lacking, in fact, informed consent for ECT is typically among the most comprehensive for any medical procedure. And that is because ECT is under the microscope in so many jurisdictions.
Most US hospitals require separate ECT and anesthesia consent forms. And while many forms specify that consent is good for a certain period, my experience is that, in most US hospitals, outpatients sign a new consent before each treatment.
"Alternative treatments" may be a bit tricky, IMO, particularly for severely ill patients. Is rTMS, or CBT, or ketamine, really an "alternative" for someone with melancholic, psychotic depression, a recent suicide attempt and significant weight loss...?
This article is worth a full, quick read (~10 minutes) despite its provinciality.
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