Patient Education and Counseling 41 (2000) 63–71 www.elsevier.com / locate / pateducou Informed consent in palliative radiotherapy: participation of patients and proxies in treatment decisions a, a a b * C.M. Verhaak , F.W. Kraaimaat , A.C.J. Staps ,W.A.J. van Daal a Department of Medical Psychology, University Hospital Nijmegen, 118 Medical Psychology, PO Box 9101, NL-6500 HB Nijmegen, The Netherlands b Institute for Radiotherapy, University Hospital Nijmegen, NL-6500 HB Nijmegen, The Netherlands Received 11 July 1998; received in revised form 9 February 1999; accepted 22 February 1999 Abstract Informed consent is regularly discussed, but little attention has been paid to the daily practice of the patient participation in treatment decisions regarding palliative care. Therefore, an exploratory study was conducted into shared decision making between radiation oncologists and patients and proxies in interviews where decisions regarding palliative radiotherapy have to be made. Interviews of 6 radiation oncologists with 26 outpatients were recorded on audiotape. Each verbal utterance was coded with the aid of the Roter Interaction Analysis System (RIAS). Results indicated that in over 75% of the interviews, patients and proxies were not asked for their opinion regarding treatment decisions. Other treatment options or the option of abstaining from treatment were discussed in 46% of the interviews. In conclusion, in this sample informed consent was not a natural part of the daily practice of palliative radiotherapy. The question remains to what extent informed consent in palliative radiotherapy is realistic.  2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Communication; Decision making; Informed consent; Palliative care; Palliative radiotherapy 1. Introduction inform the patient about the nature and purpose of the proposed examination and treatment, the ex- Informed consent ideally refers to the participation pected risks and side effects, other treatment possi- of patients in treatment decisions with a full under- bilities and the patient’s prognosis in relation to the standing of the factors relevant to their care [1]. In disease. In addition, the physician has to ask the The Netherlands, informed consent has got a legal patients for their consent for a proposed treatment. basis in the ‘Dutch Medical Treatment Agreement Informed consent presupposes patients who are well Act’. In accord with this act, the physician has to informed and who are able to understand the in- formation they received [2]. Although there is a substantial number of studies regarding informed *Corresponding author. Tel.: 1 31-24-361-7022; fax: 1 31-24- consent in the context of clinical trials, surprisingly 361-3425. E-mail address: c.verhaak@cksmps.azn.nl (C.M. Verhaak) little attention has been paid to the applicability of 0738-3991 / 00 / $ – see front matter  2000 Elsevier Science Ireland Ltd. All rights reserved. PII: S0738-3991(00)00116-6