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Essentials of Palliative Care pp 89–105Cite as

Guidance with Complex Treatment Choices

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Abstract

Palliative care often involves making difficult choices for the patient, the family, and the treating team. As the disease progresses and the evidence of scientifically robust effective therapeutic options becomes less certain, decisions tend to become more preference sensitive, where the values, goals, and priorities of the patient (and the family) gains increasing importance. In such a situation, the shared decision making model is more appropriate. The physician or the multidisciplinary team can provide guidance with complex decisions with the help of various decision support interventions, or decision aids, which help to clarify the patient’s knowledge regarding the decisions to be taken vis-à-vis personal preferences and values.

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Author information

Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India

    Sukanya Mitra M.D.

  2. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA

    Nalini Vadivelu M.D.

Authors
  1. Sukanya Mitra M.D.
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  2. Nalini Vadivelu M.D.
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Corresponding author

Correspondence to Sukanya Mitra M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1.  1.

    The following statement is not true of the paternalistic model of decision making:

    1. (a)

      Patient autonomy is the dominating bioethical principle

    2. (b)

      The shared information is primarily medical in nature

    3. (c)

      The deliberation and decision making is one way (doctor)

    4. (d)

      There is no true partnership between doctor and patient

  2.  2.

    The following statement is not true of the informed choice model of decision making:

    1. (a)

      Patient autonomy is the dominating bioethical principle

    2. (b)

      The shared information is primarily medical in nature

    3. (c)

      The deliberation and decision making is one way (doctor)

    4. (d)

      There is no true partnership between doctor and patient

  3.  3.

    The following statement is true of the shared decision making (SDM) model:

    1. (a)

      Patient autonomy is the dominating bioethical principle

    2. (b)

      The shared information is primarily medical in nature

    3. (c)

      The deliberation and decision making is one way (doctor)

    4. (d)

      There is a true partnership between doctor and patient

  4.  4.

    In the “preference-sensitive” decisions, as opposed to “effectiveness-based” decisions:

    1. (a)

      There is no single “right” decision

    2. (b)

      The paternalistic model works best

    3. (c)

      The “preference” refers to the doctor, not the patient

    4. (d)

      Is more important in the early stage of disease rather than at end-of-life care

  5.  5.

    A preference-sensitive decision becomes more important in the context of:

    1. (a)

      Disease modifying treatment

    2. (b)

      End-of-life care

    3. (c)

      Evidence-based care

    4. (d)

      Diagnosis of cancer

  6.  6.

    For guidance with complex treatment choices in palliative care, the best model is:

    1. (a)

      Paternalistic model

    2. (b)

      Informed choice model

    3. (c)

      Shared decision-making model

    4. (d)

      None of the above

  7.  7.

    The various decision support interventions have been categorized into

    1. (a)

      3 categories

    2. (b)

      4 categories

    3. (c)

      5 categories

    4. (d)

      6 categories

  8.  8.

    The International Patient Decision Aids Standards (IPDAS) is concerned with:

    1. (a)

      Classifying the numerous decision aids into coherent categories

    2. (b)

      Formulating guidelines for decision aids

    3. (c)

      Establishing an internationally approved set of criteria to determine the quality of patient decision aids

    4. (d)

      All of the above

  9.  9.

    Decision coaches are:

    1. (a)

      Computer programs

    2. (b)

      Web-based applications

    3. (c)

      Resource materials

    4. (d)

      Human beings

  10. 10.

    Specific areas of decision making at the end of life may include any of these except:

    1. (a)

      Disease-modifying therapy

    2. (b)

      Advance directives

    3. (c)

      Do not (attempt) resuscitation (DN(A)R) orders

    4. (d)

      Management of pain and other symptoms

Answers

  1.  1.

    (a)

  2.  2.

    (c)

  3.  3.

    (d)

  4.  4.

    (a)

  5.  5.

    (b)

  6.  6.

    (c)

  7.  7.

    (a)

  8.  8.

    (c)

  9.  9.

    (d)

  10. 10.

    (a)

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Mitra, S., Vadivelu, N. (2013). Guidance with Complex Treatment Choices. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_6

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  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_6

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5163-1

  • Online ISBN: 978-1-4614-5164-8

  • eBook Packages: MedicineMedicine (R0)

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