When a patient with decision-making capacity refuses a beneficial treatment, which actions should the nurse take to respect autonomy while ensuring understanding?

• A. Coerce the patient to accept treatment
• B. Involve the family to override the decision
• C. Ignore the decision and continue treatment
• D. Assess capacity, provide clear information about risks/benefits and alternatives, check comprehension, involve the patient in decisions, document discussion, avoid coercion

Answer: (D)

Respecting autonomy while ensuring understanding starts with confirming the patient can make an informed choice. Assess capacity by checking whether the patient can understand the information relevant to the decision, appreciate the consequences, reason about the options, and communicate a clear choice. If capacity is uncertain, seek additional evaluation and involve the right professionals, but do not assume incapacity.

Next, provide clear, honest information about the risks, benefits, and alternatives of the proposed treatment. Use plain language, avoid medical jargon, and explain what the treatment involves, the likelihood of benefit, possible harms, and alternatives, including the option of no treatment.

Then check comprehension to ensure the patient truly understands. A teach-back approach—ask the patient to restate the plan in their own words and ask clarifying questions—helps verify understanding.

Involve the patient in decisions by inviting values, preferences, and questions, and support their right to accept or refuse the treatment based on their own goals.

Document the discussion and the decision, including the capacity assessment, information provided, patient questions, and the final choice, along with notes that coercion was avoided.

If the patient continues to refuse a beneficial treatment and has capacity, honor their decision. If capacity is lacking, involve an appropriate surrogate or follow applicable policies.