Informed decision making and consent

Quality statement 3

Before starting bowel preparation, a patient receives comprehensive consumer-appropriate information about bowel preparation, the colonoscopy, and sedation or anaesthesia. They have an opportunity to discuss the reason for the colonoscopy, its benefits, risks, financial costs and alternative options before deciding to proceed. Their understanding is assessed, and the information provided and their consent to sedation, colonoscopy and therapeutic intervention is documented.

Purpose

To ensure that each patient is provided with adequate information and time to consider the risks and benefits of colonoscopy before providing informed consent and before starting bowel preparation or any other aspect of the procedure.

For consumers

  • If your doctor recommends that you have a colonoscopy, you will need to decide whether to go ahead with it. If you decide to have the colonoscopy, you will be asked to give consent. Giving consent means that you understand what is involved in having the colonoscopy, what the risks and benefits are, and that you agree to have the colonoscopy.

  • To help you make your decision, you will be informed about all the parts of the process including:

    • Bowel preparation – the process for clearing your bowel before the colonoscopy using medicines, changing your diet and fasting (not eating for a period of time)

    • Sedation – medicines given to minimise discomfort during the colonoscopy

    • The colonoscopy procedure – how the colonoscope is used to look at your bowel, and to help remove polyps or tissue samples.

  • The discussion will include:

    • Why the doctor is suggesting a colonoscopy

    • Benefits to your health

    • Risks of the bowel preparation, sedation and the colonoscopy

    • Risks of not having the colonoscopy

    • Any out-of-pocket costs

    • Any alternatives to colonoscopy.

  • It is important that you understand this information before giving consent and that you ask questions if you need more information before you make your decision. This should happen before you start the bowel preparation. If you need an interpreter, this can be arranged. If you choose to have the colonoscopy, your consent will be recorded in writing. Even after you have given your consent, you can ask for more information or change your mind about having the colonoscopy at any time before the colonoscopy begins.

For clinicians

Provide the patient (or their responsible decision-maker where relevant) with clear and comprehensive information about all aspects of the colonoscopy relevant to the patient’s decision and consent including the bowel preparation, sedation (or anaesthesia) the colonoscopy and any therapeutic interventions, using language that they can understand. Arrange an interpreter if required.

Tell the patient the reason for the colonoscopy, its benefits and potential adverse events including those related to the bowel preparation or sedation, perforation, bleeding (immediate and delayed) and missed pathology.

Provide information about the financial costs and the alternatives to having the colonoscopy, including any risks of not having the colonoscopy.

Provide adequate time for the patient to consider the information provided and to ask questions before consenting. Respect the patient’s decision and document it and their informed consent in the medical record, with a description of the information discussed and provided to the patient.

For health service organisations

Ensure that clear, written information is available to patients for all aspects of the colonoscopy for which the health service organisation is responsible, which may include bowel preparation, the colonoscopy and associated sedation or anaesthesia.

When consent is being obtained, ensure protocols and procedures enable patients to receive adequate information to inform their decision, are supported to ask questions and consent before the start of bowel preparation. Ensure interpreter services are accessible and their use is supported. Ensure policies and procedures support the principles and practices of informed consent and appropriate documentation. 

For consumers

  • If your doctor recommends that you have a colonoscopy, you will need to decide whether to go ahead with it. If you decide to have the colonoscopy, you will be asked to give consent. Giving consent means that you understand what is involved in having the colonoscopy, what the risks and benefits are, and that you agree to have the colonoscopy.

  • To help you make your decision, you will be informed about all the parts of the process including:

    • Bowel preparation – the process for clearing your bowel before the colonoscopy using medicines, changing your diet and fasting (not eating for a period of time)

    • Sedation – medicines given to minimise discomfort during the colonoscopy

    • The colonoscopy procedure – how the colonoscope is used to look at your bowel, and to help remove polyps or tissue samples.

  • The discussion will include:

    • Why the doctor is suggesting a colonoscopy

    • Benefits to your health

    • Risks of the bowel preparation, sedation and the colonoscopy

    • Risks of not having the colonoscopy

    • Any out-of-pocket costs

    • Any alternatives to colonoscopy.

  • It is important that you understand this information before giving consent and that you ask questions if you need more information before you make your decision. This should happen before you start the bowel preparation. If you need an interpreter, this can be arranged. If you choose to have the colonoscopy, your consent will be recorded in writing. Even after you have given your consent, you can ask for more information or change your mind about having the colonoscopy at any time before the colonoscopy begins.

For clinicians

Provide the patient (or their responsible decision-maker where relevant) with clear and comprehensive information about all aspects of the colonoscopy relevant to the patient’s decision and consent including the bowel preparation, sedation (or anaesthesia) the colonoscopy and any therapeutic interventions, using language that they can understand. Arrange an interpreter if required.

Tell the patient the reason for the colonoscopy, its benefits and potential adverse events including those related to the bowel preparation or sedation, perforation, bleeding (immediate and delayed) and missed pathology.

Provide information about the financial costs and the alternatives to having the colonoscopy, including any risks of not having the colonoscopy.

Provide adequate time for the patient to consider the information provided and to ask questions before consenting. Respect the patient’s decision and document it and their informed consent in the medical record, with a description of the information discussed and provided to the patient.

For health service organisations

Ensure that clear, written information is available to patients for all aspects of the colonoscopy for which the health service organisation is responsible, which may include bowel preparation, the colonoscopy and associated sedation or anaesthesia.

When consent is being obtained, ensure protocols and procedures enable patients to receive adequate information to inform their decision, are supported to ask questions and consent before the start of bowel preparation. Ensure interpreter services are accessible and their use is supported. Ensure policies and procedures support the principles and practices of informed consent and appropriate documentation. 

Read Quality Statement 4 - Bowel preparation