Conflicts Regarding Decisions to Limit Treatment

Goold, Susan Dorr; Williams, Brent C.; Arnold, Robert M.

doi:10.1001/jama.283.7.909

Cited by 127 publications

(57 citation statements)

References 34 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Se exploró este supuesto indagando por la presencia de algunas de las características descritas para los fenómenos complejos. Para aproximarse a su comprensión se aislaron artificialmente algunos de sus elementos -tal como lo sugiere Morin 18 . Estos se seleccionaron en razón de su posible relación (no determinista) con las decisiones y las acciones 19 e incluyeron: creencias, emociones y representaciones en cada uno de los actores que protagonizan e interactúan en la toma de decisiones al final de la vida: el paciente, el mé-dico (o enfermera, en adelante profesional de salud) y la familia.…”

Section: Antecedentesunclassified

Análisis de la toma de decisiones al final de la vida desde una perspectiva teórica contemporánea

Medina¹,

Cruz²,

Jaramillo³

et al. 2015

RCB

View full text Add to dashboard Cite

ResumenSe realizó una investigación cualitativa para describir el proceso de decisiones al final de la vida (DFV) bajo el supuesto de que se trata de un fenómeno complejo y dinámico. Con base en entrevistas a profundidad a pacientes, familiares y personal de salud y en fuentes secundarias se analizaron las DFV a partir de teorías de decisión basadas en el principio de racionalidad limitada. Se encontró que las DFV exhiben características observadas en los fenómenos complejos como son múltiples componentes fusionados, relaciones variadas, simultáneas, impredecibles, cambiantes y dependientes de las circunstancias. La mayoría de los entrevistados utilizan el método intuitivo para tomar decisiones basándose en rutas de pensamiento cortas: creencias arraigadas, principios, fórmulas y juicios que han demostrado éxito previamente. Aunque se advierte un discurso de respeto por las elecciones del paciente, existen jerarquías instituidas e imaginadas en las que predomina el médico en lugar más alto. El dolor, la disnea y la dependencia progresiva son una fuerte presión para las DFV. También lo es la deficiente atención de los enfermos terminales y sus familias puesto que reduce las opciones a las que el paciente puede tener acceso.Palabras clave: atención terminal, toma de decisiones, procesos mentales, creencias, muerte. AbstractA qualitative study was conducted to describe the process of making end-of-life decisions (ELD) under the assumption that it is a complex and dynamic phenomenon. ELD were analyzed from decision theory based on the principle of bounded rationality on the basis of in-depth interviews with patients, families, and health professionals. It was found that ELD had features observed in other complex phenomena as multi-*

show abstract

Section: Antecedentesunclassified

Análisis de la toma de decisiones al final de la vida desde una perspectiva teórica contemporánea

Medina¹,

Cruz²,

Jaramillo³

et al. 2015

RCB

View full text Add to dashboard Cite

show abstract

“…Especially when facing a frightening and unfamiliar future near the end of life, patients and their families commonly turn to an experienced family member, physician, or religious leader for guidance and may designate such a person to make decisions. 44 Goold et al 45 report that families facing end-of-life decisions in the ICU desire more guidance than they routinely receive. Forcing decision making on a patient or family also overrides rather than promotes autonomy.…”

Section: Respect For Autonomy Vs Forcing Information or Decision Makimentioning

confidence: 99%

On Patient Autonomy and Physician Responsibility in End-of-Life Care

Billings

Krakauer²

2011

Arch Intern Med

View full text Add to dashboard Cite

In current medical practice, excessive or reflexive deference to an unreflective concept of patient autonomy may inadvertently compromise patient autonomy by placing unwanted and unreasonable responsibility for technical medical decisions on patients or their surrogate decision makers rather than on their physicians. Such practices can harm patients by depriving them of the expert, professional advice they both need and deserve to make important decisions about their health care. We describe herein how the patient-physician relationship has evolved in recent decades as more life-sustaining and life-saving treatments, such as cardiopulmonary resuscitation, have become available. We then examine respect for patient autonomy and describe how patient autonomy can be promoted while the physician's responsibility for technical medical decisions is simultaneously affirmed. The patient is the expert on his or her values, goals, and preferences, while the physician is the expert on the medical means for honoring the patient's perspective. We conclude that an intervention, such as cardiopulmonary resuscitation, should not be offered when, based on the patient's own criteria, it promises no physical or psychosocial benefit or would be far more harmful than beneficial.

show abstract

“…Social behaviors such as communication and social style like warmth, sensitivity, positive outlook, and even temper are all important factors for a successful patient-physician relationship (13). Some researchers have shown that conflict resolution approches are necessary to emphatise a patient (14)(15)(16). Empathic processes and intrapersonal outcomes increase helping behavior and reduce aggressive behavior, encourage conflict avoidance, improve conflict management and promote good communication (17).…”

Section: Introductionmentioning

confidence: 99%

Comparison of empathy skills and conflict tendency in preclinical and clinical phase Turkish medical students: a cross-sectional study

Atay¹,

Sarı²,

Demirhan³

et al. 2014

Dusunen Adam

View full text Add to dashboard Cite

Comparison of empathy skills and conflict tendency in preclinical and clinical phase Turkish medical students: a cross-sectional study Objective: Empathy skills and personal conflicts which may change over time by social, environmental and educational factors, are both important components for a succesful patient-physician relationship. We sought to investigate the empathy levels and conflict tendencies in medical students considering the phase of medical education Method: One hundred and eighty six students were included from first, fourth and sixth year medical students. A sociodemographic data form, Emphatic Skills Scale-B-Form and Conflict Tendency Scale were administered to all participants.Results: The mean scores of empathy skills did not differ across males and females. Passive antithetical conflict was higher in females, active conflict score was higher in year one students. A significant increase was found in empathy in last year. Total conflict tendency was higher in students who were not satisfied with their medical education. Existantial conflict was found to be decreased with increasing empathic skills. Conclusion:There is a significant difference between year one and year six in medical students for active conflict tendency, and better empathy skills are present in year six students. Sonuç: Aktif çatışma eğilimi açısından tıp öğrencilerinde birinci ve altıncı yıllar arasında anlamlı fark vardır, empatik becerilerin de altıncı yıl öğrencilerinde daha iyi olduğu belirlenmiştir.

show abstract

Conflicts Regarding Decisions to Limit Treatment

Cited by 127 publications

References 34 publications

Análisis de la toma de decisiones al final de la vida desde una perspectiva teórica contemporánea

Análisis de la toma de decisiones al final de la vida desde una perspectiva teórica contemporánea

On Patient Autonomy and Physician Responsibility in End-of-Life Care

Comparison of empathy skills and conflict tendency in preclinical and clinical phase Turkish medical students: a cross-sectional study

Contact Info

Product

Resources

About