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July 28, 2010

Patient-Centered Care and Informed Consent

JAMA. 2010;304(4):409-410. doi:10.1001/jama.2010.1028

To the Editor: In his Commentary, Dr Krumholz1 stated that the patient-centered decision-making process may be improved by providing patients with a standardized and personalized informed consent document. Standardized, procedure-specific consent forms such as those proposed are the core of the Department of Veterans Affairs Electronic Support for Patient Decisions Initiative.2 Since the deployment of that system in 2005, numerous institutions have adopted automated systems that produce consent documents written for patients with low medical literacy and limited English proficiency. Krumholz worried that a standardized approach risks precluding personalized medicine. If the consent form were the only means of communication with the patient, this might be true. However, informed consent should be a process of discussion between the clinician and the patient. The consent form merely summarizes the discussion that should have taken place. In a study of one Veterans Affairs medical center, the use of an electronic process to facilitate and document the informed consent discussion was preferred by 96% of patients.3