Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-pjpqr Total loading time: 0 Render date: 2024-06-14T16:53:33.407Z Has data issue: false hasContentIssue false

6 - Discussing Treatment Decisions

When You’re at a Crossroads

Published online by Cambridge University Press:  05 April 2024

Robert M. Arnold
Affiliation:
The University of Pittsburgh School of Medicine, Pittsburgh
Anthony L. Back
Affiliation:
University of Washington Medical Center
Elise C. Carey
Affiliation:
Mayo Clinic, Minnesota
James A. Tulsky
Affiliation:
Dana-Farber Cancer Institute, Boston
Gordon J. Wood
Affiliation:
Northwestern Memorial Hospital, Chicago
Holly B. Yang
Affiliation:
Scripps Health, San Diego, California
Get access

Summary

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.

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further Reading

Ariely, D., Predictably Irrational: The Hidden Forces that Shape Our Decisions. HarperCollins, New York, 2008.Google Scholar
Chapman, A. R., Litton, E., Chamberlain, J., and Ho, K. M., The effect of prognostic data presentation format on perceived risk among surrogate decision makers of critically ill patients: A randomized comparative trial. J Crit Care, 2015, 30(2): 231–5.CrossRefGoogle ScholarPubMed
Chewning, B., Bylund, C., Shah, B., Arora, N. K., Gueguen, J. A., and Makoul, G., Patient preferences for shared decision-making: A systematic review. Patient Educ Couns, 2012, 86(1): 918.CrossRefGoogle ScholarPubMed
Epstein, R. M., Alper, B. S., and Quill, T. E., Communicating evidence for participatory decision making. JAMA, 2004, 291(19): 2359–66.CrossRefGoogle ScholarPubMed
Groopman, Jerome, How Doctors Think. Mariner Books, Boston, 2008.Google Scholar
Harrington, S. E. and Smith, T. J., The role of chemotherapy at the end of life: “When is enough, enough?JAMA, 2008, 299(22): 2667–78.CrossRefGoogle Scholar
Kaldjian, L. C., Curtis, A. E., Shinkunas, L. A., and Cannon, K. T., Goals of care toward the end of life: A structured literature review. Am J Hosp Palliat Med, 2008, 25(6): 501–11.Google ScholarPubMed
Lidz, C. W., Meisel, A., Osterweis, M., et al., Barriers to informed consent. Ann Intern Med, 1983, 99(4): 539–43.CrossRefGoogle ScholarPubMed
Ruhnke, G. W., Tak, H. J., and Meltzer, D. O., Association of preferences for participation in decision-making with care satisfaction among hospitalized patients. JAMA Netw, 2020, 3(10): e2018766.CrossRefGoogle ScholarPubMed
Schwarze, M. L. and Taylor, L. J., Managing uncertainty: Harnessing the power of scenario planning. New Engl J Med, 2017, 377(3): 206–08.CrossRefGoogle ScholarPubMed
Smith, T. J., Tell it like it is. J Clin Oncol, 2000, 18(19): 3441–5.CrossRefGoogle ScholarPubMed
Sox, H., Blatt, M. A., Higgins, M. C., and Marton, K. I., Medical Decision Making. American College of Physicians, Philadelphia, 2006.Google Scholar
Taylor, L. J., Nabozny, M. J., Steffens, N. M., et al., A Framework to improve surgeon communication in high-stakes surgical decisions: Best case/worst case. JAMA Surg, 2017, 152(6): 531–8.CrossRefGoogle ScholarPubMed
White, D. B., Ernecoff, N., Buddadhumaruk, P., et al., Prevalence of and factors related to discordance about prognosis between physicians and surrogate decision-makers of critically ill patients. JAMA, 2016, 315(19): 2086–94.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×