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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 8: Sudden Illness
    Seven Guiding Principles

    Principle 3. Identify Decision Points in Advance Principle 4. Use the General Goals of Care to Guide Decision-Making

    Principle 3. Identify Decision Points in Advance

    Importance of Patient & Family Involvement in Decision-Making

    • Informed participation of the patient and family in health care and medical decisions is important for many reasons:
      • It demonstrates respect for the individual, perhaps the most important of the ethical principles governing medical care

      • It maximizes the likelihood that health decisions will be made with the patient’s best interests in mind

      • It improves the likelihood that the therapeutic goals of care will actually be achieved

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    Identifying Future Decision Points

    • It is particularly helpful to identify decision points in advance
    • Clarify which decisions need to be made immediately and those that will need to be made in the near future
        For Example
        A patient may have need for immediate respiratory support and vasopressors for stabilization, but the possibility of hemodialysis may or may not become an issue. Let the family know how you will determine whether or not dialysis will need to be considered. For instance, you may need time to determine the metabolic gap after respiratory stabilization. Let the family know what kind of information you will be giving them about dialysis if it becomes relevant
    • Even when things are uncertain, the physician should be very clear that there will be decisions to be made
    • All options for care are open for discussion, from aggressive attempts to reverse the disease to purely comfort measures

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    Structuring Discussions with Family Members

    • Begin preparing the family early for decisions to be made in the future
        For Example
        "We’ve talked about what we know at this point. Now let’s talk about the future and what we can expect to happen"
    • The earlier the family knows what discussions will be needed, the better they can organize themselves psychologically and logistically for the decisions they will need to make
    • At each meeting, set expectations about when you will meet again, and what information you will need to discuss
        For Example
        "I’ll talk to you again in the morning. At that point we should have more information from the tests and can talk better about whether dialysis is a good choice"

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    Involving Other Team Members

    • Use other members of the health care team to:
      • Support the patient and family
      • Reinforce the plan that has been determined
    • Be sure to let them know the details and rationale for the plan you have established
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