title: Patients' predilections regarding informed consent for hospital treatments.
abstract: BACKGROUND
  Respect for patient autonomy is a core principle of American medicine. Informed consent is required for surgical procedures and blood transfusions but not for most medical treatments of hospitalized patients.
  
  
  OBJECTIVE
  If given the option, patients want to give permission for common medical therapies during hospitalization.
  
  
  METHODS
  Participants in the study were patients admitted to the medical service of a 350-bed community teaching hospital.
  
  
  METHODS
  A questionnaire comprising 4 scenarios of varying risk/benefit ratios was administered to all patients who agreed to participate.
  
  
  RESULTS
  A total of 634 patients were admitted to the medicine service between June and August 2006. Two hundred and ten patients (103 men, 107 women), with a mean age (+/- SE) of 63.3 +/- 1.1 years, agreed to answer the questionnaire. Of these patients, 85% wished to participate in even trivial medical decision making (ie, potassium supplementation), 92% wished to participate in treatments with moderate risk (ie, diuretic for congestive heart failure). When a risk was initially posed as less than a 5% risk of brain hemorrhage and benefits of therapy were substantially higher (eg, thrombolysis for pulmonary embolus), 93% wanted to make the decision. If the risk of brain hemorrhage was 20% or greater, 95% wanted to make the decision. Younger patients (<65 years) were more likely to prefer requiring doctors to obtain their "permission no matter what" than were older patients (>or=65 years), and older patients were more likely to waive consent across levels of risk.
  
  
  CONCLUSIONS
  Most acutely ill hospitalized medicine patients wished to participate in even the most mundane aspects of their medical decision making. Although it is not logistically feasible to obtain informed consent for every treatment of every hospitalized patient, clinicians should be aware of patients' predilections and might consider offering opportunities for patients to participate in clinical decision making, especially for therapies that carry substantial risk.
authors.affiliation: Bridgeport Hospital and Yale University School of Medicine, Bridgeport, CT 06610, USA.
authors.forename: Shweta
authors.initials: S
authors.lastname: Upadhyay
authors.forename: Andrew
authors.initials: A
authors.lastname: Beck
authors.forename: Adeel
authors.initials: A
authors.lastname: Rishi
authors.forename: Yaw
authors.initials: Y
authors.lastname: Amoateng-Adjepong
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Manthous
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004522:Educational Status; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D007258:Informed Consent / Q000523:psychology* / Q000592:standards; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D026684:Personal Autonomy; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data