Domain 1 - Patient and Family Centered Decision Making
Recognize the patient and the family as the unit of care:
- Assess and document who comprises the family; it may not be a traditional one.
Assess the patient’s and family’s decision-making style and preferences:
- Clarify and document level of participation patient and/or family desire in choosing treatment options.
Address conflicts in decision making within the family and between staff and family:
- Explicitly address conflicts that arise within families and help families resolve these conflicts.
- Explicitly address conflicts that arise between staff and family members.
- Train staff in conflict resolution techniques.
Assess together with appropriate clinical consultants, the patient’s capacity to participate in decision-making about treatment and document assessment.
Initiate advance care planning with the patient and family:
- Take the lead in involving patient and/or family in treatment decisions by convening a family conference with members of the health care team and available family members. If patient is able to participate, hold conference at the bedside.
Clarify and document the status of the patient’s advance directive:
- If the patient has completed an advance directive, review with the patient and/or family upon admission to the ICU and document discussion
- Place the advance directive in the chart and “flag” the chart.
Identify the health care proxy and surrogate decision-maker:
- For patients who lack decision-making ability, assess and document the family’s knowledge of the patient’s verbal wishes and goals about treatment.
Clarify and document resuscitation orders:
- Distinguish do-not-resuscitate (DNR) orders from withholding and withdrawing life-sustaining treatment; policies and guidelines for these should be distinct.
- Document discussions with patient and/or family about cardiopulmonary resuscitation (CPR).
- Utilize preprinted “family discussion sheet” where informal and formal discussions with family members may be documented.
Assure patients and families that decision making by the health care team will incorporate their preferences.
Follow ethical and legal guidelines for patients who lack both capacity and a surrogate decision-maker:
- Establish a written policy detailing these guidelines.
Establish and document clear, realistic and appropriate goals of care in consultation with the patient and family:
- Ensure that treatments reflect the goals of care.
- Identify a time frame for the reassessment of treatment goals and set up follow-up meetings with the patient and/or family to discuss progress towards goals.
Help the patient and family assess the benefits and burdens of alternative treatment choices as the patient condition changes.
Forgo life-sustaining treatments in a way that ensures patient and family preferences are elicited and respected:
- Develop pathways to improve the quality of care in the setting of withdrawing life-sustaining treatments.
Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. |