Recognizing the Dying Patient, When Less Could be More: A Diagnostic Framework for Shared Decision-Making at the End of Life

Kalsi, Dilraj; Ward, Joel; Lee, Regent; Wee, Bee; Fulford, K. W. M.; Handa, Ashok

doi:10.1177/2374373519869153

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…Discussions with patients and families about preferences and wishes at end-of-life including resuscitation status and TEP form part of the process of ACP ( 25 ). Timely recognition of the vulnerability of cancer patients with COVID-19 and prompt, open communication regarding ACP can facilitate high-quality end-of-life care ( 26 ). Recognising dying patients, however, is a skill that requires experience.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Experiences for Cancer Patients Dying in Hospital with COVID-19

McFarlane

Halley

Kano

et al. 2022

Journal of Patient Experience

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Despite a wealth of research regarding COVID-19, little evidence exists about cancer patients’ specific needs and experiences at end-of-life. This study retrospectively describes the care of 34 hospitalised cancer patients dying with COVID-19. The palliative care needs of patients were described. The main domains of end-of-life care service provision were evaluated including treatment of pain and other symptoms, communication and decision making at end-of-life and level of involvement of the palliative care team. Physical symptoms were managed with relatively low doses of end-of-life medications. High levels of patient and family anxiety, however, highlight the complexity of death from a stigmatised disease. Prompt acknowledgement of the vulnerability of advanced cancer patients with COVID-19 can facilitate proactive symptom management, anticipatory communication and enhance family support.

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Section: Discussionmentioning

confidence: 99%

End-of-Life Experiences for Cancer Patients Dying in Hospital with COVID-19

McFarlane

Halley

Kano

et al. 2022

Journal of Patient Experience

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“…SDM is useful in this regard, as it has been strongly linked to facilitating “good deaths.” There are several challenges in to overcome in smoothly transitioning patients to Palliative Care, including patient and relative education and earlier discussion of available treatment options . The latter can only be achieved through earlier recognition and discussion of dying through tools such as Oxford's diagnostic framework for shared decision‐making at the end of life …”

Section: Community Carementioning

confidence: 99%

Shared decision‐making across the specialties: Much potential but many challenges

Kalsi

Ward

Lee

et al. 2019

Evaluation Clinical Practice

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Shared decision‐making (SDM) is a collaborative process through which patients and clinicians work together to arrive at a mutually agreed‐upon treatment plan. The use of SDM has gathered momentum, with it being legally mandated in some areas; however, despite being a ubiquitously applicable intervention, its maturity in use varies across the specialties and requires an appreciation of the nuanced and different challenges they each present. It is therefore our aim in this paper to review the current and potential use of SDM across a wide variety of specialties in order to understand its value and the challenges in its implementation. The specialties we consider are Primary Care, Mental Health, Paediatrics, Palliative Care, Medicine, and Surgery. SDM has been demonstrated to improve decision quality in many scenarios across all of these specialties. There are, however, many challenges to its successful implementation, including the need for high‐quality decision aids, cultural shift, and adequate training. SDM represents a paradigm shift towards more patient‐centred care but must be implemented with continued people centricity in order to realize its full potential.

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“…Healthcare professionals encounter many healthcare conditions for which SDM can be helpful and applied, such as choice of labor after a previous Cesarean section [ 4 ], selection of dialysis modality [ 5 ], options for smoking cessation [ 6 ], location of end-of-life hospice [ 7 ], treatment for acute myeloid leukemia [ 8 ], treatment of de-escalation regimens in patients with RA on remission [ 9 ], management of valve heart disease [ 10 ], and breast reconstruction for patients with breast cancer [ 11 ]. Clinicians tend to make decisions based on medical knowledge and evidence, while patients are sensitive to the rigors of recovery and quality of life [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Establishing the Competency Development and Talent Cultivation Strategies for Physician-Patient Shared Decision-Making Competency Based on the IAA-NRM Approach

Hsu

Wang

et al. 2022

Healthcare

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Shared decision making (SDM) is a collaborative process involving patients and their healthcare workers negotiating to reach a shared decision about medical care. However, various physician stakeholders (attending physicians, medical residents, and doctors in post-graduate years) may have different viewpoints on SDM processes. The purpose of this study is to explore the core competence of physicians in performing SDM tasks and to investigate the significant competency development aspects/criteria by applying the literature research and expert interviews. We adopt the IAA (importance awareness analysis) technique for different stakeholders to evaluate the status of competency development aspects/criteria and to determine the NRM (network relation map) based on the DEMATEL (decision-making trial and evaluation laboratory) technique. The study combines the IAA and NRM methods and suggests using the IAA-NRM approach to evaluate the adoption strategies and common suitable paths for different levels of physicians. Our findings reveal that SDM perception and practice is the primary influencer of SDM competence development for all stakeholders. The current model can help hospital administrators and directors of medical education understand the diverse stakeholders’ perspectives on the core competence of SDM tasks and determine common development plans. It provides strategic directions for SDM competency development and talent cultivation programs.

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Recognizing the Dying Patient, When Less Could be More: A Diagnostic Framework for Shared Decision-Making at the End of Life

Cited by 5 publications

References 15 publications

End-of-Life Experiences for Cancer Patients Dying in Hospital with COVID-19

End-of-Life Experiences for Cancer Patients Dying in Hospital with COVID-19

Shared decision‐making across the specialties: Much potential but many challenges

Establishing the Competency Development and Talent Cultivation Strategies for Physician-Patient Shared Decision-Making Competency Based on the IAA-NRM Approach

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