Table 1 Relationship between coded physician behaviors and shared decision-making (adapted from White[30]and Charles[25])
From: Involvement of ICU families in decisions: fine-tuning the partnership
Dimension of shared decision-making | Coded physician behaviors | Practical example |
|---|---|---|
Providing medical information | 1. Discuss the nature of the decision. | 1. Last week, we told you that he had severe cardiac insufficiency. But now, the stroke makes his/her odds of immediate survival very dismal |
What is the essential clinical issue we are addressing? | ||
2. Describe treatment alternatives | 2. Instead of performing the tracheostomy now, we could extubate him/her and see if it works | |
What are the clinical reasonable choices? | ||
3. Discuss the pro and cons of the choices | 3. Each strategy has strengths and weaknesses, and it is important to balance each strategies | |
4. Discuss uncertainty | 4. We are beginning new antibiotics for this VAP, but his/her status may worsen | |
What is the likelihood of success of treatment? | Â | |
5. Assess family understanding | 5. Check whether family has actually grasped which decision is being made and what are its consequences | |
Is the family an informed participant with a working understanding of the decision | ||
Eliciting patient's values and preferences | 6. Elicit patient's values and preferences | 6. As you know him/her well since a long time, could you please tell us what he would have said if he/she were sharing this discussion with us |
What is known about patient's preferences and values? | ||
Exploring the family's preferred role in decision-making | 7. Discuss the family's role in decision-making | 7. Family should be offered a role in decision-making even if some will decline |
8. Assess the need for input from others | 8. Is the primary physician, the general practitioner, or any close friend that the family would like to consult? | |
Is there anyone else the family would like to consult? | ||
Deliberating and decision-making | 9. Explore the context of the decision | 9. Terminal weaning with likely immediate death versus decision of no escalation of treatment |
How will the decision affect the patient's life? | ||
10. Elicit the family's opinion about the treatment decision | 10. The decision is that we are not going back to surgery as it is likely to fail and to prolong unnecessary suffering. What do you think of this decision? | |
What does the family think is the most appropriate decision for the patient |