In order to promote patient self-determination and as part of informed consent, a physiotherapist must adequately disclose not only the benefits but also the risks of treatment to patients. This guideline outlines the principles of disclosing the risks of treatment.
It is to be considered in relation to the College of Physiotherapists of Alberta’s Performance of Restricted Activities and Client-centered Care Practice Standards and Informed Consent Guideline. Guidelines are intended to supplement practice standards. Practice standards describe the minimum performance expectations for physiotherapist service provision.
“A physiotherapist’s duty to disclose is linked to the informed consent process.”
Principles guiding disclosure of treatment risks
- Physiotherapists are responsible for regularly reviewing resources that identify and quantify risks associated with the treatment they are performing.
- Physiotherapists have a higher level of knowledge about associated risks and consequences than their patients. As such physiotherapists are responsible for judging the relevancy of the risks of their technique and determining which risks should be discussed with a patient.
- Patients have a right to self-determine what treatments they receive.
- Physiotherapists are expected to adequately disclose information about a proposed course of treatment to their patients for the purpose of enabling patients to make informed choices about receiving treatment.a
- Risks will vary based on the technique used, patient’s unique circumstances (including but not limited to the presence of comorbid conditions), area of body to be treated and the practitioner’s competence (i.e., risk of pneumothorax is non-existent if dry needling is limited to peripheral limbs, risk of fainting may be higher in a person with diabetes if blood sugars are not managed appropriately prior to dry needling, and risk of vertebrobasilar stroke from manipulation is non-existent if thoracic or lumbar spine is treated).
- Informed consent is expected to be obtained from each patient for each specific treatment rendered and the clinical record must contain evidence of the consent process (i.e., ensure your patient understands and consents to the various techniques you are using).
- The treating physiotherapist is responsible for ensuring patient consent is informed.
- Reasonable attempts should be made to communicate risks and to ensure a patient understands a proposed treatment technique and its risks.
- Patients should be provided with an opportunity to ask and have any questions answered about the proposed technique/treatment.
Information that should be disclosed to patients
Physiotherapists are duty bound to disclose the following related to a proposed technique:
- Nature and purpose of treatment
- Benefits of treatment
- Material and special risks
- Material risks are those known to be associated with the procedure and commonly occur (e.g., pain, bruising, bleeding, drowsiness, post treatment pain) that a reasonable person would want to know when deciding to receive treatment.
- Special risks are those that are highly unlikely but have severe consequences or have special relevance to the patient. (e.g., pneumothorax when needling in thorax or lower cervical region or pain in hand or wrists following needling when the patient is a piano player who has a concert the following day).
- The probability or severity of an adverse outcome should be communicated to the patient when there is data available on the risks.
- Other information including alternatives to the proposed treatment. An alternative may be no treatment at all.
Expected patient outcomes from the disclosure process
- Has had an opportunity to ask questions.
- Indicates they understand and are comfortable with risks of current and any new techniques introduced.
- Voluntarily consents to procedure free from coercion, undue influence or intentional misrepresentation.
- Indicates that they understand they can withdraw consent at any time.
- Is able to describe what to do and who to contact if adverse events/outcomes occur while attending and following departure from the clinic.
Note: Failure to adequately disclose information to patients and obtain informed consent can be grounds for negligence lawsuits and findings for disciplinary proceedings.