Decision support: helping patients and families to find a balance at the end of life

Abstract

Terminally ill patients and their families face many decisions at the end of life that can sometimes be overwhelming. Nurses play a key role in providing decision support so that patients and their families can make timely decisions about their health care that reflect their individual needs and circumstances. The Ottawa Decision Support Framework can help nurses to assess patients' decision-making needs, provide tailored decision support and evaluate the effect of their interventions. The theoretical underpinnings of the model and its implications for palliative care clinical practice are discussed.

Palliative Medicine and Decision Science: The Critical Need for a Shared Agenda To Foster Informed Patient Choice in Serious Illness

“…5 SDM has been defined as a relationship among patients, family, and one or more health professionals where the participants clearly establish the decision that needs to be made, discuss the options (including outcomes of options), elicit patients' values and preferences associated with those options, and engage patients or their surrogates, to the extent desired, in making and implementing a decision. 19,20 SDM constitutes an ethical imperative to include patients and their families in health care decision making. 21 SDM brings together the patient and family members who are experts in the biography of the illness and personal values with health care professionals who are experts in the disease and recovery process.…”

Transitions Model: Melding of Psychotherapy and Palliative Care Using Teams

“…This model has a strong counseling base in providing palliative service (Mosenthal & Murphy, 2006), rather than major reliance on advanced practice nurses or palliative physicians and is intended to diminish conflict, improve communication, manage time constraints, and provide knowledge (Davidson, Daly, Brady, & Higgins, 1994;Gade et al, 2008;Radwany et al, 2009;Bendaly, Grovers, Juliar, Gramelspacher, 2008;Murray, Miller, Fiset, O'Connor, & Jacobsen, 2004;Nelson et al, 2010).…”

Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs

“…The tool is grounded in the Cognitive Emotional Decision Making (CEDM) framework, the Ottawa Decision Support Framework, and empirical research on systems-level barriers to clinician-family communication [28,[34][35][36][37][38][39]. Expanding on the traditional decision aid model [40,41], the broad goal of the tool is to promote effective communication and shared decision making between clinicians and patients' surrogates, as delineated in a framework developed by Charles et al [42], further specified for the ICU environment in existing practice recommendations for family support in ICUs [43][44][45][46][47][48][49].…”