Informed Consent Requires that Patients Have a Choice and a Voice
Guest Column by Paulette Moulton, M.D
All too common skin cancer underscores the need for all health care consumers to take an active role, in partnership with their doctors, in choosing their form of treatment.
Skin cancer, one of the most prevalent forms of cancer, provides a prime example of the importance of truly informed consent. Each year, some 3.4 million Americans are diagnosed with skin cancer – 3.3 million with nonmelanoma basal or squamous cell carcinoma, and 84,000 with melanoma.
More often than not, informed consent consists of a patient signing a form that explains the procedure that is about to be performed and lists the potential side effects and complications.
All patients should be educated about all medically appropriate options all the time. In the case of nonmelanoma skin cancer, options include Mohs surgery and Image-Guided Superficial Radiotherapy, among others.
Each year, more than a million Americans undergo Mohs surgery, where specially trained dermatologists cut away at cancerous skin and examine the edges of the excised tissue to make sure all the cancer is removed. They cut as little as necessary to preserve healthy skin and minimize damage, and the process can take from a few hours to a full day. Some side effects include bleeding, pain, infection, temporary or permanent numbness at the surgical site, and surgical scarring.
Image-Guided Superficial Radiotherapy, or Image-Guided SRT is a recent advancement in the treatment of skin cancer. It uses low levels of X-ray energy to kill cancer cells without harming adjoining healthy tissue.
Ultra-sound imaging allows the healthcare professional to visualize the dimensions of the tumor, calculate the correct treatment dose, and define the treatment area. Image-Guided SRT is delivered in a dermatologist’s office, typically during two-to-three short and painless sessions per week, over four to seven weeks. There is no cutting, bleeding, surgical scarring, or need for reconstructive surgery.
More than one tumor can be treated during a course of care, which is important because, on average, 1.6 tumors are detected at diagnosis. Image-Guided SRT’s cure rate of 99 percent compares favorably to Mohs surgery cure rates of 98 percent for basal cell carcinoma and 96 percent for squamous cell carcinoma.
Doctors have an obligation to fully inform their patients of all reasonable treatment options, including even those that may require referring the patient to another health care provider who has the training, experience or technology to provide other forms of treatment. Patients, too, have a profound role to play in treatment selection, requiring them to learn about their options, engage their doctors in meaningful discussion, and make thoughtful decisions.
The process of arriving at fully informed consent can be truly empowering, resulting in improved health outcomes, and greater confidence and respect for our health care system. Every patient should have a choice and a voice in their own health care.
Paulette Moulton, M.D., is a board certified dermatologist in Monroe, Michigan.