NZREX Patient Communication & Informed Consent β Questions and Answers
Question 1: Which of the following best describes 'informed consent' under the NZ Code of Health and Disability Services Consumers' Rights?
- Voluntary agreement given after receiving adequate information, understanding it, and having capacity to decide (Correct answer)
- A signed form completed before any procedure
- Agreement obtained from the next of kin when the patient is present
- Verbal agreement only, with no documentation required
Correct answer: Voluntary agreement given after receiving adequate information, understanding it, and having capacity to decide
Under Right 7 of the Code, informed consent requires: the patient has capacity, information has been provided and understood, consent is freely given without coercion, and the patient has the right to withdraw. A signature confirms but does not replace genuine informed consent.
Question 2: A 16-year-old presents alone requesting contraception. She appears to understand the information provided. What is the legal position regarding consent in New Zealand?
- A 16-year-old can consent to medical treatment independently under the Care of Children Act 2004 (Correct answer)
- She requires parental consent for any medical treatment
- She can only receive emergency treatment without parental consent
- She must have a social worker present
Correct answer: A 16-year-old can consent to medical treatment independently under the Care of Children Act 2004
Under the Care of Children Act 2004, a person aged 16 or over can consent to medical, surgical, or dental procedures as if they were an adult. Under 16, the Gillick/Fraser competence principles apply β the child may consent if they understand the information.
Question 3: When explaining a diagnosis of cancer to a patient, which communication approach is recommended?
- Use clear language, pause frequently, check understanding, allow silence, and invite questions (Correct answer)
- Deliver all information at once to be efficient
- Avoid telling the patient and inform family first
- Use medical jargon to appear competent
Correct answer: Use clear language, pause frequently, check understanding, allow silence, and invite questions
Breaking serious news (SPIKES protocol) involves a structured approach: check what the patient knows, ask how much they want to know, give information in clear chunks, explore emotions, summarise, and plan. Patient-centred communication improves coping and trust.
Question 4: A patient has capacity but refuses a blood transfusion that the doctor believes is life-saving. What is the correct action?
- Respect the refusal, document it thoroughly, and explore the patient's reasons and wishes (Correct answer)
- Proceed with transfusion as duty of care overrides refusal
- Seek a court order to override the decision
- Contact next of kin to give consent instead
Correct answer: Respect the refusal, document it thoroughly, and explore the patient's reasons and wishes
A competent adult has an absolute right to refuse medical treatment, even if the refusal is unwise or life-threatening. The doctor must respect this, document carefully, ensure the patient understands consequences, and continue to provide care within the patient's wishes.
Question 5: Which of the following is NOT a valid reason to override a patient's right to confidentiality?
- The patient's partner requests information about their diagnosis (Correct answer)
- Risk of serious harm to an identifiable third party
- Statutory requirement (e.g., notifiable disease reporting)
- Direct patient care within a treating team
Correct answer: The patient's partner requests information about their diagnosis
Confidentiality cannot be overridden simply because a partner or family member requests information. Valid exceptions include disclosure to prevent serious harm to others, statutory obligations, and sharing within the treating team on a need-to-know basis.
Question 6: Which model of patient communication is most aligned with the NZ Code's emphasis on partnership and shared decision-making?
- Collaborative/shared decision-making model (Correct answer)
- Paternalistic model
- Informative model only
- Interpretive model only
Correct answer: Collaborative/shared decision-making model
Shared decision-making (collaborative model) aligns with the Code's emphasis on patient autonomy and partnership. It involves exploring patient values and preferences alongside clinical evidence to reach a mutually agreed treatment decision.
NZREX Patient Communication & Informed Consent
Which of the following best describes 'informed consent' under the NZ Code of Health and Disability Services Consumers' Rights?