title: Negotiating consent: exploring ethical issues when therapeutic massage bodywork practitioners are trained in multiple therapies.
abstract: BACKGROUND
  Obtaining informed consent from competent patients is essential to the ethical delivery of health care, including therapeutic massage and bodywork (TMB). The informed consent process used by TMB practitioners has not been previously studied. Little information is available about the practice of informed consent in a treatment-focused environment that may involve multiple decision points, use of multiple TMB therapies, or both.
  
  
  METHODS
  As part of a larger study on the process of providing TMB therapy, 19 practitioners were asked about obtaining informed consent during practice. Qualitative description was used to analyze discussions of the consent process generally, and about its application when practitioners use multiple TMB therapies.
  
  
  RESULTS
  Two main consent approaches emerged, one based on a general consent early in the treatment process, and a second ongoing consent process undertaken throughout the course of treatment. Both processes are constrained by how engaged a patient wants to be, and the amount of information and time needed to develop a truly informed consent.
  
  
  CONCLUSIONS
  An understanding-based consent process that accommodates an acknowledged information differential between the patient and practitioner, and that is guided by clearly delineated goals within a trust-based relationship, may be the most effective consent process under the conditions of real practice conditions.
authors.affiliation: School of Nursing, Faculty of Applied Sciences, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Antony J
authors.initials: AJ
authors.lastname: Porcino
authors.affiliation: Office of Medical Bioethics, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Page
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Boon
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Marja J
authors.initials: MJ
authors.lastname: Verhoef
keywords: clinical practice; complementary therapies/methods; consent; decision-making; massage; musculoskeletal manipulations; qualitative research