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6 - Discussing Treatment Decisions

When You’re at a Crossroads

Published online by Cambridge University Press:  05 April 2024

Robert M. Arnold
The University of Pittsburgh School of Medicine, Pittsburgh
Anthony L. Back
University of Washington Medical Center
Elise C. Carey
Mayo Clinic, Minnesota
James A. Tulsky
Dana-Farber Cancer Institute, Boston
Gordon J. Wood
Northwestern Memorial Hospital, Chicago
Holly B. Yang
Scripps Health, San Diego, California
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Discussing treatment options is more complex than giving information and making a recommendation. Today, shared decision making includes patient access to the electronic medical record and internet searches, however patients still turn to their clinicians as the most important and trusted source. In addition to balancing information and emotion, clinicians need to take into account how involved patients wish to be in decision making. A roadmap for discussing treatment decisions is: 1. Prepare for the visit, 2. Frame the decision to be made, 3. Ask about decision-making preferences explicitly, 4. Adapt the discussion and recommendations based on patient decision-making preferences (shared decision making, clinician-led decision making, pros/cons), 5. Check for patient understanding, 6. Establish how the patient wants to proceed with the decision-making process. Take care with how statistics are presented and consider providing decision aides. Asking patients how they want to make decisions will help ground decisions in their values.

Navigating Communication with Seriously Ill Patients
Balancing Honesty with Empathy and Hope
, pp. 89 - 100
Publisher: Cambridge University Press
Print publication year: 2024

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Further Reading

Ariely, D., Predictably Irrational: The Hidden Forces that Shape Our Decisions. HarperCollins, New York, 2008.Google Scholar
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Lidz, C. W., Meisel, A., Osterweis, M., et al., Barriers to informed consent. Ann Intern Med, 1983, 99(4): 539–43.CrossRefGoogle ScholarPubMed
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