Aiding end-of-life medical decision-making: A Cardinal Issue Perspective

[...]sharing of end-of-life decisions in practice happens infrequently due to factors such as time constraints, inadequate communication, clinical situations (e.g., sensitive topics, including end-of-life discussions), and patient characteristics (e.g., older age and poor health condition; White et...

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Bibliographic Details
Published in:Palliative & supportive care 2020-02, Vol.18 (1), p.1-3
Main Authors: Yan, Haoyang, Kukora, Stephanie K, Arslanian-Engoren, Cynthia, Deldin, Patricia J, Pituch, Kenneth, Yates, J Frank
Format: Article
Language:English
Subjects:
Clinical decision making
Communication
Decision Making
Humans
Palliative care
Patients
Terminal Care - methods
Terminal Care - trends
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Summary:[...]sharing of end-of-life decisions in practice happens infrequently due to factors such as time constraints, inadequate communication, clinical situations (e.g., sensitive topics, including end-of-life discussions), and patient characteristics (e.g., older age and poor health condition; White et al., 2007; Joseph-Williams et al., 2014). [...]a patient or a surrogate decision maker who is unaware of palliative medicine options and long-term implications of life-sustaining treatments may later find that the decision is in conflict with personal values and the outcomes not as expected (Teno et al., 2000; Nelson et al., 2005). [...]we suggest using the 10 cardinal issues checklist (Yates, 2003) for clinicians, patients, and surrogate decision makers to scrutinize decision-making at each phase to smooth the communication process and maximize the chance of making an effective decision (Table 1 for an end-of-life decision example). Need emphasizes bringing up the decision problem at the right time and discussing the urgency of the decision, giving clinicians, patients, and surrogate decision makers opportunities to discuss the benefits and risks of watchful waiting vs. actively making a decision, e.g., continuing current treatments and withdrawing life support. [...]clinicians and decision makers may sometimes think that an understanding of information and values will automatically lead to a decision, so it is important to provide specific guidance to resolve Tradeoffs among options — how the pros and cons of each option should be weighed against each other in order to make a decision.
ISSN:1478-9515
1478-9523
DOI:10.1017/S1478951519000981