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Help!! My patient keeps changing her mind about whether she's willing to undergo the medication and treatment regimen prescribed to treat her cancer. She seems mentally competent to me, but she's clearly ambivalent about this regimen. When I ask her why she's uncertain, she shrugs me off. The physician and I have both tried to convince her to say a firm yes or no-and she does, in writing, but then she changes her mind the next morning. Whenever she says no, I don't press her on it, but the regimen isn't going to work well with a sporadic approach. What, legally, should be our next step?-G.S., FLA.
To give informed consent, the patient must understand the options available and their significant risks and benefits. These should be explained in terms she can understand so that she grasps the implications of her decision.
If your patient is highly ambivalent, perhaps she doesn't fully understand the treatment she's consenting to receive. Don't try to convince her to give you a firm yes or no; you could be accused of coercion. She may simply need more information from the physician, including why a consistent regimen will give her the best chance for a good outcome.
Keep in mind that her right to consent includes the right to withdraw consent at any time, orally or in writing. If she withdraws consent, honor her refusal. Document her statement, and notify the other team members who need to know.
Document completely your patient's decision (in her own words if possible) and your compliance with her directions in her medical record. Documenting the informed consent process is also important, but this is the physician's role, not yours. As a nurse, you can witness the patient's signature on the informed consent document, but the physician must obtain consent for treatment he prescribes.
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