| Essential components of trauma-informed consent |
| Trauma-informed care is "a universal framework designed to deliver respectful care to all persons that hinges on patient autonomy, safety, and trust, while avoiding trauma or retraumatization."1,2 |
| The trauma informed care framework involves:3 - An awareness of the prevalence of trauma
- An understanding of the impact of trauma on physical, emotional, and mental health as well as on behaviors and engagement to services
- An understanding that current service systems can retraumatize individuals
|
| "Consent is a clear dialogue between individuals to engage in a specific activity. Expectations for consent to intimate examinations in health care should be equal to, if not exceed, expectations for intimate interactions in society."4 |
| "Consent is a process that equalizes the ability to respond either yes or no."4 |
| Trauma informed consent also includes:1,4 - Awareness and mitigation of power differences between patients and care providers
- Active awareness of individual’s verbal as well as non-verbal (eg, pulling away, closing legs) cues that consent is not given, rescinded, or that the person is in distress
- Explicitly stating that any examination is within the patient’s control and that the provider will pause or stop as directed by the patient
- Ensuring ongoing respectful care5,6
|
| Essential components of informed or shared decision-making |
| Shared decision-making is "a deliberative process of active engagement and collaboration between a health care provider and individual, which explores the available options of medical interventions for a particular condition, in order to implement a plan based upon the best available evidence and congruent with the individual’s preferences, values, and needs."7 - Informed consent is "a competent individual’s intentional and voluntary authorization of a medical intervention, given through a process in which a health care provider discloses information regarding the risks and benefits of the proposed intervention."7
- Informed refusal is "the corollary to informed consent, whereby the individual declines to provide authorization for a proposed medical intervention."7
- Informed choice is "a deliberative process by which an individual makes a decision for or against a proposed intervention based upon good knowledge and understanding, with little or no decisional conflict and consistent with the individual’s values."7
|
| Shared decision-making also includes:1,8 - Beginning the process with an assessment of the individual's desire to participate in shared decision making and to what extent9,10
- Plentiful time for individual deliberation and consideration, in consultation with their family/support team. In the event of urgent or emergent clinical care needs, the individual's right to decline care should be respected9,10
- Understanding that shared decision making is an evolving process that is repeated as needed throughout care provision9,10
|
