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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 ,
Anthony L. Back ,
Elise C. Carey ,
James A. Tulsky ,
Gordon J. Wood  and
Holly B. Yang
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
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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.

Keywords

crossroadsinformed consentgoals concordant careshared decision making
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

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References

Further Reading

Ariely, D., Predictably Irrational: The Hidden Forces that Shape Our Decisions. HarperCollins, New York, 2008.Google Scholar
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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): 9–18.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
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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
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

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