decision making at end of life

Question 1

2 main aspects of making goals of care decisions

Answer 1

1. shared decision making

2. informed consent

Question 2

4 parts of shared decision making

Answer 2

1. explore pt/family preferred role
2. elicit pt values
3. provide info
4. deliberation and decision making

Question 3

4 parts of meeting

Answer 3

1. prep
2. 1st half
3. 2nd half
4. summarize

Question 4

parts of 1st half

Answer 4

• intro
• defuse tension
• establish rapport
• active listening
• open ended Qs

Question 5

parts of second half

Answer 5

• present info
• establish goals of care
• agree on Tx plan

Question 6

**3 parts of consent

Answer 6

1. informed
2. capable
3. voluntary

Question 7

4 broad Tx cats

Answer 7

1. full code
2. DNR with ICU admission
3. DNR without ICU admission
4. comfort only

Question 8

4 model of deicsion making

Answer 8

1. parental - phys is guardian
2. interpretive - phys is counsellor
3. informative/consumer - phys is tech
4. deliberative - phys is teacher

Question 9

what is effect of CPR and ventilation

Answer 9

not very good and people think it worls better

- lots of SE

Question 10

what are fears

Answer 10

• fear of neglect
• ## bizarrre requests

Question 11

what is autonomy

Answer 11

• must be informed and advised

- shifting responsibilty to patient/family is NOT respecting autonomy

Question 12

5 parts to bottom line

Answer 12

• communication process is important
• explore understanding
• explore values
• explain concerns
• frame ACP as contingency plan

Question 13

2 types of advanced care plans

Answer 13

1. power of attorney

2. living will

Question 14

5 myths about why not to tell

Answer 14

1. doesn’t want to know- most people do
2. conversation is traumatic
3. will become depressed
   - no correlation
4. pos. attitude will help overcome
   - no diff
5. going to die, so not big diff.
   - can do lots of things

Question 15

4 different views on non-benefical Tx

Answer 15

1. not effective
2. not cost-effective
3. effective, but too high burdens
4. proces related issues

Question 16

what are problems with NBTs

Answer 16

• lower QOL
• shorter suvival
• more dep/anx in caregiver
• higher burnout
• costs

Question 17

what is impact of consent and CPR

Answer 17

• default is to provide

- DNR is a change in Tx plan

Question 18

what is substitute decision making based on

Answer 18

• priors applicable capable wish of PT

- if not avail - best interests of PT

Question 19

what is capacity and consent board

Answer 19

parajudical board for mental health issues

Question 20

3 roles of consent and cap board

Answer 20

1. consider if prior wish is applicable
2. consider wish from SDM to vary from prior capable wish
3. review SDMs compliance with rules

Question 21

5 other things we can do

Answer 21

1. communicate
2. document
3. mediate
4. challenge as appropriate
5. become comfortable with discomfort