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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?  
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