Professional recommendations: disclosing facts and values

Βaylis, Françoise; Downie, Jocelyn

doi:10.1136/jme.27.1.20

Cited by 25 publications

(7 citation statements)

References 4 publications

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“…Ethicists have delineated several potential limitations to physicians’ recommendations, including the possibility that physicians’ personal biases will unduly influence their recommendations (45, 46) and that the power differential between physicians and patients/surrogates may render the recommendations unduly influential (47, 48). An experimental study using healthy volunteers revealed that physicians’ recommendations can sway individuals to make illogical treatment decisions (49).…”

Section: Discussionmentioning

confidence: 99%

Expanding the paradigm of the physicianʼs role in surrogate decision-making: An empirically derived framework*

White

Malvar

Karr

et al. 2010

Critical Care Medicine

144

116

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Background Little is known about what role physicians take in the decision-making process about life support in intensive care units. Objective To determine how responsibility is balanced between physicians and surrogates for life support decisions and to empirically develop a framework to describe different models of physician involvement. Design Multi-centered study of audio-taped clinician–family conferences with a derivation and validation cohort. Setting Intensive care units of four hospitals in Seattle, Washington, in 2000 to 2002 and two hospitals in San Francisco, California, in 2006 to 2008. Participants Four hundred fourteen clinicians and 495 surrogates who were involved in 162 life support decisions. Results In the derivation cohort (n = 63 decisions), no clinician inquired about surrogates’ preferred role in decision-making. Physicians took one of four distinct roles: 1) informative role (7 of 63) in which the physician provided information about the patient’s medical condition, prognosis, and treatment options but did not elicit information about the patient’s values, engage in deliberations, or provide a recommendation about whether to continue life support; 2) facilitative role (23 of 63), in which the physician refrained from providing a recommendation but actively guided the surrogate through a process of clarifying the patients’ values and applying those values to the decision; 3) collaborative role (32 of 63), in which the physician shared in deliberations with the family and provided a recommendation; and 4) directive role (1 of 63), in which the physician assumed all responsibility for, and informed the family of, the decision. In 10 out of 20 conferences in which surrogates requested a recommendation, the physician refused to provide one. The validation cohort revealed a similar frequency of use of the four roles, and frequent refusal by physicians to provide treatment recommendations. Conclusions There is considerable variability in the roles physicians take in decision-making about life support with surrogates but little negotiation of desired roles. We present an empirically derived framework that provides a more comprehensive view of physicians’ possible roles.

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Section: Discussionmentioning

confidence: 99%

Expanding the paradigm of the physicianʼs role in surrogate decision-making: An empirically derived framework*

White

Malvar

Karr

et al. 2010

Critical Care Medicine

144

116

View full text Add to dashboard Cite

show abstract

“…‘What would you do if you were me, doctor?’ is a question that is often posed to doctors when individuals have a decisional conflict and when they are unsure which treatment to choose. 1 By asking this question, patients expect doctors to go beyond giving professional advice and reveal their personal preferences by imagining themselves in the patient's situation. 2 Many patients believe that doctors, when deciding for themselves, would choose the best option 3 since they are free from strategic considerations (for example financial limitations, physicians’ self-interests).…”

mentioning

confidence: 99%

‘What would you do if you were me, doctor?’: randomised trial of psychiatrists' personalv.professional perspectives on treatment recommendations

et al. 2010

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“…[15, 19-22] When 515 psychiatrists were randomized to different experimental counseling conditions, posing the question, “What would you do?,” did not motivate providers to shift their professional recommendation and take on a more personal perspective. [20] Regarding periviable treatment recommendations, a simulation-based study of 10 neonatologists’ periviable counseling behaviors, found that most declined parental requests for treatment recommendations.…”

Section: Discussionmentioning

confidence: 99%

“Doctor, what would you do?”: Physicians’ responses to patient inquiries about periviable delivery

Edmonds

McKenzie

Panoch

et al. 2015

Patient Education and Counseling

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Objective To qualitatively assess obstetricians’ and neonatologists’ responses to standardized patients (SPs) asking “What would you do?” during periviable counseling encounters. Methods An exploratory single-center simulation study. SPs, portraying a pregnant woman presenting with ruptured membranes at 23 weeks, were instructed to ask, “What would you do?” if presented options regarding delivery management or resuscitation. Responses were independently reviewed and classified. Results We identified 5 response patterns: ‘Disclose’ (9/28), ‘Don't Know’ (11/28), ‘Deflect’ (23/28), ‘Decline’ (2/28), and ‘Ignore’ (2/28). Most physicians utilized more than one response pattern (22/28). Physicians ‘deflected’ the question by: restating or offering additional medical information; answering with a question; evoking a hypothetical patient; or redirecting the SP to other sources of support. When compared with neonatologists, obstetricians (40% vs. 15%) made personal or professional disclosures more often. Though both specialties readily acknowledged the importance of values in making a decision, only one physician attempted to elicit the patient's values. Conclusion “What would you do?” represented a missed opportunity for values elicitation. Interventions are needed to facilitate values elicitation and shared decision-making in periviable care. Practice Implications If physicians fail to address patients’ values and goals, they lack the information needed to develop patient-centered plans of care.

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Professional recommendations: disclosing facts and values

Abstract: Abstract

Cited by 25 publications

References 4 publications

Expanding the paradigm of the physicianʼs role in surrogate decision-making: An empirically derived framework*

Expanding the paradigm of the physicianʼs role in surrogate decision-making: An empirically derived framework*

‘What would you do if you were me, doctor?’: randomised trial of psychiatrists' personalv.professional perspectives on treatment recommendations

“Doctor, what would you do?”: Physicians’ responses to patient inquiries about periviable delivery

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