Future states: the axioms underlying prospective, future-oriented, health planning instruments

Koch, Tom

doi:10.1016/s0277-9536(00)00154-4

Cited by 18 publications

(13 citation statements)

References 29 publications

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“…This finding suggests that another major source of uncertainty may be an accurate evaluation of the inherent uncertainty and complexities of medical decision making (Ditto, et al, 2006; Halpern & Arnold, 2008; Koch, 2001). Some have suggested that if patients are fully informed of the consequences of their decisions, it is expected, and perhaps desired, for patients to have increased decisional uncertainty (McNutt, 2004).…”

Section: Discussionmentioning

confidence: 99%

“…These decisions usually focus on whether patients would want to receive life-sustaining treatments for end-of-life care, such as mechanical ventilation, in the event of a medical crisis. Advance treatment decisions are often difficult because they require patients to project their preferences into the future and fully appreciate unknown health states (Ditto, Jacobson, Smucker, Danks, & Fagerlin, 2006; Halpern & Arnold, 2008; Koch, 2001). For example, patients are often asked to consider health states they have never experienced such as: “If I am in a coma…” (Emanuel, Barry, Stoeckle, Ettelson, & Emanuel, 1991) “If you were to become so sick you may die soon…”(Sudore, et al, 2007) “Imagine you have severe dementia” (Pearlman, Starks, Cain, & Cole, 2005).…”

Section: Introductionmentioning

confidence: 99%

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Uncertainty About Advance Care Planning Treatment Preferences Among Diverse Older Adults

Sudore¹,

Schillinger²,

Knight³

et al. 2010

Journal of Health Communication

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The complexities associated with advance treatment decisions may result in decisional uncertainty and poorly informed choices, particularly among vulnerable populations such as minorities and patients with limited health literacy. Using a hypothetical scenario, we assessed uncertainty about treatment preferences among 205 chronically-ill, English/Spanish-speaking older adults from a county outpatient clinic in San Francisco. Participants were read a scenrio that described a very poor health state and poor outcome of life support treatment. Participants were asked to imagine that they were in this scenario and to choose either: all life support (LS) treatments; try LS with an option of stopping; or no LS. They were then asked how certain they were about this decision. Forty five percent of participants were uncertain about their decision. In adjusted multivariate analysis, Latinos and Asian/Pacific Islanders were more likely than Whites to be uncertain about their treatment decisions as were participants with limited versus adequate literacy and poor versus good self-rated health. Many patients may be uncertain about advance treatment preferences. Culturally sensitive, literacy-appropriate tools are needed to address decisional uncertainty and to help patients prepare for decision making about their future health care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Uncertainty About Advance Care Planning Treatment Preferences Among Diverse Older Adults

Sudore¹,

Schillinger²,

Knight³

et al. 2010

Journal of Health Communication

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“…Individuality of an AD is therefore often considered as one of the main indicators of quality (Lack 2008 ). Patients’ treatment preferences and values change as their health changes (Halpern and Arnold 2008 ; Loewenstein 2005 ; Koch 2001 ), at the end of life (Fried et al 2007 ), and even during periods of stable health (Fried et al 2007 ). GPs in this study shared their concern over making ADs with patients who are still healthy because they fear patients would not be able to consistently anticipate future scenarios and treatment preferences.…”

Section: Discussionmentioning

confidence: 99%

The utility of standardized advance directives: the general practitioners’ perspective

Otte

Elger

Jung

et al. 2016

Med Health Care and Philos

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Advance directives (AD) are written documents that give patients the opportunity to communicate their preferences regarding treatments they do or do not want to receive in case they become unable to make decisions. Commonly used pre-printed forms have different formats. Some offer space for patients to (a) appoint a surrogate decision maker, and/or (b) to determine future medical treatments and/or (c) give a statement of personal values. So far it is unknown which forms GPs preferably use and why they decide to do so. 23 semi-structured interviews with GPs were analysed using content analysis. Interviewees mainly use short templates (to appoint surrogate decision makers) and medium length templates with checkboxes to indicate patients’ preferences in regards to life prolonging measures. Especially when patients faced the progression of a disease, participants use the latter version. Only then, the interviewees remarked, patients are capable to rate concrete situations reliably. GPs also realize the importance of the verbal assessment of patients’ preferences; however they rarely keep a written form of the conversation. Some GPs hand out one or more templates and ask their patients to read and think about them at home with the option to talk to them about it later on, while others prefer their patients to fill them out alone at home. Regardless of template usage, most GPs emphasize that ADs require regular updates. GPs tend to see standardized advance directives mainly as a tool to start a conversation with their patients and to identify their real preferences and values. When the patient is still not facing the progression of an already existing disease it could be sufficient to only appoint a surrogate decision maker instead of creating a full AD. However, in all other situations, appointing a surrogate decision maker should be backed up by a written statement of a patient’s general values. Patients and their relatives should always have the opportunity to ask their GP for medical advice when drafting an AD. It is crucial to regularly verify and update existing ADs within the course of a disease.

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“…Individuals have difficulty predicting what they would want in future circumstances because these predictions do not reflect one's current medical, emotional, or social context (17-22). In addition, patients' treatment preferences and values change with changes in health (19, 23-25), at the end-of-life (26-28), and even during periods of stable health (26).…”

Section: Problems With the Traditional Objective Of Advance Care Planmentioning

confidence: 99%

Redefining the “Planning” in Advance Care Planning: Preparing for End-of-Life Decision Making

Sudore

Fried²

2010

Ann Intern Med

712

656

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The traditional objective of advance care planning has been to have patients make treatment decisions in advance in an attempt to provide care consistent with their goals. We argue that the objective for advance care planning ought to be the preparation of patients and surrogates to participate with clinicians in making the best possible in-the-moment medical decisions. We provide practical steps for clinicians to help patients and surrogate decision makers achieve this objective in the outpatient setting. Preparation for in-the-moment decision making shifts the focus from having patients make premature decisions based on incomplete information to preparing patients and their surrogates for the types of decisions and conflicts they may encounter when they do have to engage in in-the-moment decision making. This approach does not preclude the completion of advance directives, but acknowledges that they are but one piece of information to be used at the time of decision making.

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Future states: the axioms underlying prospective, future-oriented, health planning instruments

Cited by 18 publications

References 29 publications

Uncertainty About Advance Care Planning Treatment Preferences Among Diverse Older Adults

Uncertainty About Advance Care Planning Treatment Preferences Among Diverse Older Adults

The utility of standardized advance directives: the general practitioners’ perspective

Redefining the “Planning” in Advance Care Planning: Preparing for End-of-Life Decision Making

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