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Updated: Jul 10, 2026

E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Informed consent for colonoscopy. A prospective study.
1Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn. 06510.
Most patients desire physician guidance, and physicians often view patients as less autonomous, indicating that the paternalistic model influences the physician-patient relationship despite informed consent practices.
Area of Science:
- Medical Ethics
- Health Communication
- Patient-Physician Relationship
Background:
- Informed consent is standard in medicine, but patient autonomy's practical application in decision-making is unclear.
- The physician-patient relationship is often characterized by autonomy or paternalistic models.
- Colonoscopy provides a suitable context to examine patient involvement in medical decisions.
Purpose of the Study:
- To evaluate the extent of patient autonomy in medical decision-making during informed consent.
- To assess patient preferences for involvement in treatment decisions.
- To understand physicians' perceptions of patient autonomy.
Main Methods:
- Prospective survey of 102 outpatients undergoing colonoscopy.
- Survey of 16 physicians involved in colonoscopy procedures.
- Analysis of patient and physician perspectives on decision-making roles.
Main Results:
- A majority of patients preferred receiving guidance from their physicians.
- Most physicians did not perceive their patients as fully autonomous.
- The paternalistic model appears to remain influential in physician-patient interactions for this procedure.
Conclusions:
- Physician-patient dynamics in colonoscopy decision-making lean towards paternalism.
- Patient desire for guidance coexists with physician perceptions of limited patient autonomy.
- Further research is needed to fully integrate patient autonomy into everyday medical practice.
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