The tradition of medical decision making based on professional paternalism does not deal well with the complex trade-offs created by modern technology. Rates of elective surgery and other discretionary interventions are determined in large part by practice style and, sometimes, by geographic variation in resources.
The intensity of decision making is magnified when life-threatening illness is involved.
The stakes feel very high for every choice that arises. You may, for instance, be deciding whether to stay at home or move to a hospital, or how to approach challenges with eating and drinking. All of these decisions can feel complicated and difficult. This article has some ideas about how to make the decision-making process more manageable.
Almost all decisions related to health care in palliative situations can be approached by using the following framework: Be informed about the issues being considered. Determine the goals for whatever is being considered. Determine whether the hoped-for goals are possible to achieve and plan an approach accordingly.
Be informed Information is the foundation on which we build our approach to health care decisions. You and the health care team must be as informed as possible about what is being considered, and about the potential outcomes of different choices. Determine the goals From a strong foundation of information you can begin to explore the choices about tests, treatments, and other health care considerations.
This exploration should be guided by the goals that you are hoping to achieve. In a way, goals are like a lens that focuses our thinking. What do you hope to achieve?
For example, a patient may be assuming that chemotherapy is being given with the goal of curing a cancer, while the doctor may be hoping to decrease its size or slow its progression. For example, they may review and explain test results or help explore treatment options such as medications, radiation treatments, or surgery.
Sometimes families will want to try a particular treatment in hopes that it will improve certain symptoms. The team will be able to provide insight into whether that goal is medically possible. The role of the patient and family Some goals cannot be measured by the health care team.
For example, only the patient can say whether a specific treatment provides more energy or makes it easier to breathe. As a result, the health care team must look to the patient and family for insight into whether certain treatments make the patient feel better.
Likewise, only the patient and family can voice goals relating to their own values or belief systems. The role of the patient and family is to bring these goals forward so that they can be considered in the decision-making process.
Whose goals are they? For most people living with terminal illnesses, a time usually arises where they would not want further tests or treatments.
However, if someone is not well enough to take part in discussions about care options, family members may be asked about whether they feel it is time to limit certain treatments such as antibiotics or blood transfusions, especially when death is near. Making decisions for someone else comes with a tremendous sense of responsibility.
Family members may sometimes feel as though they are deciding whether their loved one lives or dies, when in fact this outcome has been determined by the illness.Clinical decision support provides timely information, usually at the point of care, to help inform decisions about a patient's care.
Clinical decision support can effectively improve patient outcomes and lead to higher-quality health care. We propose the following definition of a decision tool: A 'decision tool' is an active knowledge resource that uses patient data to generate case-specific advice which support decision making about individual patients by health professionals, the patients themselves or others concerned about them.
“The visual presentation of risks and benefits really helps [the patients] feel like they are owning their health care decisions.” Alexis Eastman, MD, UW Health “HealthDecision helps me put shared decision making at the forefront of my counseling.”. Shared decision making recognizes that there are complex trade-offs in the choice of medical care.
Shared decision making also addresses the ethical need to fully inform patients about the risks and benefits of treatments, as well as the need to ensure that patients' values and preferences play a .
Health Care Decisions: An Approach to Decision Making and Advance Care Planning By: Mike Harlos MD, CCFP(PC), FCFP Making decisions about health care can seem overwhelming at times. Summary of Health Care Decision Statutes Enacted in ; Health Care Decision-Making in Clinical Settings.
This research project launches a major study of how health care providers make health care decisions for patients in a clinical setting who lack capacity and have nothing in writing naming a person to make health care decisions.