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Informed Consent for Chemotherapy Administration

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Consent to treatment is an important part of the delivery of quality cancer care. Best practices dictate that consent conversations should be well documented. One way to document consent is through a written consent form that is reviewed with the patient, signed, and stored in the patient’s chart. Making a detailed note in a patient’s chart to document that all of the required elements of a consent conversation took place is equally appropriate, as written consent forms are not required by law in most states.

In response to member interest, members of ASCO’s Ethics and Quality of Care Committees formed a joint working group to design a modifiable template consent form for patients receiving chemotherapy. The template, and an annotated user's guide are provided below in modifiable format to allow practice customization.

  1. Consent to Chemotherapy template (modifiable Microsoft Word document)
  2. Chemotherapy Consent Use and Discussion Guide (modifiable Microsoft Word document): Suggests points for physicians to consider when communicating to patients about treatment options.

Use of the ASCO consent template is entirely voluntary and does not imply ASCO’s endorsement of any physician practice, treatment regimen, or product. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this template, any changes made to this template by the user, or any errors or omissions.