When asked about setting limits on medical treatment in the face of severe illness, patients and their families often respond that they want "everything." Clinicians should not take this request at face value, but should instead use it as the basis for a broader discussion about what "doing everything" means to the patient.
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How can doctors better understand patients'preferences?
Despite these challenges, many doctors are committed to understanding patients' preferences. Innovative research is being undertaken to find solutions to these problems. The imaginative use of different sources of information, together with evidence based decision aids and decision analysis, are likely to be useful. Supplementary Material
How can patients'views about treatment options be valued?
For patients' views about treatment options to be valued and necessary, there must be a partnership between doctor and patient, but establishing one requires both time and certain skills.
Will patients become increasingly involved in making treatment decisions?
The expectation that patients will become increasingly involved in making treatment decisions poses new challenges for doctors. This article discusses what these are and how doctors might face them
Do inequalities in health care perpetuate or exploit patient preferences?
Some doctors may wish to uphold the imbalance of power between themselves and their patients, which may make patients reluctant to share their preferences. Inequalities in health care may be perpetuated or exacerbated if these affect patients' preferences or the extent to which doctors seek to inform or understand them.
What are treatment preferences?
Documented treatment preferences, as appropriate to the patient's condition, may include, but are not limited to: Blood transfusion. CPR preference. Dialysis. Hospitalization or transfer preference.
How do you treat the patients?
No matter what the disease or condition, all evaluation and treatment of patients must involve caring, investigation of all complaints, respect for the patient's perspective, avoidance of excessive testing, and joint decision making regarding treatment, to the extent that is possible.
How do you discuss treatment options with patients?
It is appropriate to personalize the risks of treatment according to the patient's age and other risk factors. Consider relevant patient values. First, listen to the patient. Their questions and comments are a reflection of their concerns based on their values.
Why are patient preferences important?
Along with clinical guidelines, patient preferences provide direction for selecting treatment options and tailoring interventions. Patient preferences also help inform choice in clinical decisions where science has yet to provide dominant solutions to health care problems.
What is shared decision making in pediatrics?
Shared decision-making in pediatrics is based on a trusting partnership between parents, clinicians, and sometimes patients, wherein all stakeholders explore values and weigh options. Within that framework, clinicians often have an obligation to provide guidance. We describe a range of ethically justifiable clinician directiveness that could be appropriate in helping families navigate serious pediatric illness. The presentation of "default" options and informed nondissent as potential strategies are discussed. The degree of clinician directiveness may vary even for decisions that are equally "shared." A myriad of factors affect how directive a clinician can or should be. Some of the most important factors are the degree of prognostic certainty and the family's desire for guidance, but others are important as well, such as the urgency of the decision; the relationship between the clinician, patient, and family; the degree of team consensus; and the burdens and benefits of therapy. Directiveness should be considered an important tool in a clinician's armamentarium and is one that can be used to support families in stressful and emotionally difficult situations.
Why do physicians recommend hospice?
For example, physicians may recommend hospice for a terminally ill patient because it best meets their needs, but the patient and their family dislike this advised option. We explore whether regulatory non-fit could be used to improve these types of situations. Across five studies in which participants imagined receiving upsetting advice from a physician, we demonstrate that regulatory non-fit between the form of the physician’s advice (emphasizing gains vs. avoiding losses) and the participants’ motivational orientation (promotion vs. prevention) improves participants’ evaluation of an initially disliked option. Regulatory non-fit de-intensifies participants’ initial attitudes by making them less confident in their initial judgments and motivating them to think more thoroughly about the arguments presented. Furthermore, consistent with previous research on regulatory fit, we showed that the mechanism of regulatory non-fit differs as a function of participants’ cognitive involvement in the evaluation of the option. © 2016 by the Society for Personality and Social Psychology, Inc.
What are the challenges facing geriatric patients with limited prognosis?
This chapter reviews the unique challenges facing geriatric patients with limited prognosis; the core concepts of palliative and hospice care; existing concepts and tools of prognostication in the elderly; techniques to facilitate goals of care discussion; and the means by which effective planning for end‐of‐life care can occur. It focuses on models of prognosis for dementia and debility, as both are common conditions under which patients can often meet hospice admission criteria. The chapter provides the hospitalist with practical guidance surrounding these important aspects of comprehensive care for the older patient. Decisions regarding goals of care can involve not only the goals of the patient, but often those of multiple family members. For this reason, a section is structured around the planning and implementation of a family meeting during which prognosis and goals of care are discussed.
What is the responsibility of an emergency physician?
Palliative and end-of-life care, once the purview of oncologists and intensivists, has also become the responsibility of the emergency physician. As our population ages and medical technology enables increased longevity, it is essential that all medical professionals know how to help patients negotiate the balance between quantity and quality of life. Emergency physicians have the opportunity to educate patients and their loved ones on how to best accomplish their goals of care while also enhancing quality of life through treatment of symptoms. The emergency physician must be aware of the ethical and medico-legal parameters that govern decision making. Copyright © 2014 Elsevier Inc. All rights reserved.
What is the hidden curriculum in medical school?
Today’s medical training environment exposes medical trainees to many aspects of what has been called “the hidden curriculum.” In this article, we examine the relationship between two aspects of the hidden curriculum, the performance of emotional labor and the characterization of patients and proxies as “bad,” by analyzing clinical ethics discussions with resident trainees at an academic medical center. We argue that clinicians’ characterization of certain patients and proxies as “bad,” when they are not, can take an unnecessary toll on trainees’ emotions. We conclude with a discussion of how training in ethics may help uncover and examine these aspects of the hidden curriculum.
What is the purpose of the ICU review?
The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU. Recent Findings The need to communicate effectively and empathetically with patients and identify primary goals of care is an essential part of trauma care in the ICU. The optimal design to support complex communication in the ICU will be dependent on institutional experience and resources. The best/worst/most likely model provides a structural model for communication. Summary We have an imperative to improve the communication for all patients, not just those at the end of their life. A structured approach is important as is involving family at all stages of care. Communication skills can and should be taught to trainees.
What is the role of leadership in interprofessional health teams?
In interprofessional health teams the need for coordinating leadership and the (dynamical) need for appropriate clinical expertise to come to the fore involves a tension between the traditional role of the team leader as authority figure and the collaborative leadership which enables individual team members to emerge as leaders in their area of expertise and to relinquish this leadership as needed. Complexity analysis points to an understanding of leadership as an emergent property of the team. We discuss how a framework of mindful leadership addresses the implications of this emergent leadership model, and how Appreciative Inquiry provides a structured process for examination of team vision, values and behaviour standards.
