Facilitating Informed Consent in Medical Travel

Challenges facing medical travel patients

1. The addition of more parties offering health advice – such as medical tourism facilitators and multiple destination providers, may complicate how effectively potential risks are communicated to medical travelers, thus compromising their ability to achieve informed consent.
2. Language barriers may compromise communication between medical travelers and healthcare professionals abroad, thus limiting risk-related communication.
3. Medical travelers may experience more difficulty in verifying the credentials and training of destination physicians, further complicating the patient’s understanding of risk.
4. In some instances, medical travel may strain relationships with the patient’s primary care physician and other local medical professionals, hindering the gathering of medical advice. Follow up care back home for medical tourists can be challenging as they may have difficulty contacting the destination physician should complications or questions arise post-operatively, which can poses a post-operative health risk.
5. Cultural or religious norms as potential barriers to achieve informed consent. For example, some groups may forbid certain medical procedures or treatments – even in emergency situations – due to cultural or religious beliefs. Other cultural groups may involve people in the decision making process that may not traditionally be involved in the making of a medical decision. Still others may have different views on who it is that should be informed of the patient’s condition.
6. If the procedure or treatment is performed in a foreign country (with different laws and regulations), traveling patients may not have a clear understanding of their legal recourse if unanticipated events were to occur.
7. Patients who have traveled long distances over multiple time zones may feel disoriented and fatigued (especially if the treatment is scheduled shortly after arrival), which could hinder the patient’s understanding of risk.
8. Patients who travel alone may feel stress and anxiety without the emotional support of a family member or close friend.

Communication challenges that impact patient understanding.

1. The destination physician can mitigate these risks by communicating with the patient prior to travel to evaluate patient understanding and address miscommunications.
2. Additionally, healthcare providers should be very selective about the medical travel facilitators they choose to work with and set clear boundaries and expectations regarding their role as intermediaries as opposed to providers of healthcare services.
3. To minimize the impact of language barriers, appropriate communication tools and materials should be made available based on the patient’s language preferences. For example, interpreters need to be readily available and consent forms may need to be translated into the languages of the primary patient target markets.[8]

Travel related stressors

1. The healthcare provider should assign a patient advocate to personally assist the patient through the entire care experience, answering questions, monitoring patient understanding and ensuring the patient has discussed the elements of informed consent with the appropriate caregiver.
2. For patients who travel long distances (especially if unaccompanied), the healthcare provider may want to consider instituting a policy whereby patients are encouraged to schedule the procedure or treatment at least a day or two after their arrival in the destination in order to allow sufficient time for rest and to adapt to the time change.
3. The healthcare provider may want recommend that patients travel with a companion who can provide emotional and physical support during the care process.