Titrating guidance: a model to guide physicians in assisting patients and family members who are facing complex decisions.

Full Abstract

Over the last century, developments in new medical treatments have led to an exponential increase in longevity, but, as a consequence, patients may be left with chronic illness associated with long-term severe functional and cognitive disability. Patients and their families are often forced to make a difficult and complex choice between death and long-term debility, neither of which is an acceptable outcome. Traditional models of medical decision making, however, do not fully address how clinicians should best assist with these decisions. Herein, we present a new paradigm that demonstrates how the role of the physician changes over time in response to the curved relationship between the predictability of a patient's outcome and the chance of returning to an acceptable quality of life. To translate this model into clinical practice, we propose a 5-step model for physicians with which they can (1) determine at which point the patient is on our model; (2) identify the cognitive factors and preferences for outcomes that affect the decision-making process of the patient and his or her family; (3) reflect on their own reaction to the decision at hand; (4) acknowledge how these factors can be addressed in conversation; and (5) guide the patient and his or her family in creating a plan of care. This model can help improve patient-physician communication and decision making so that complex and difficult decisions can be turned into ones that yield to medical expertise, good communication, and personal caring.

Learn Faster Today Improve your study skills

Author information

Author/s: Goldstein, Nathan E (NE); Back, Anthony L (AL); Morrison, R Sean (RS);

Affiliation: Hertzberg Palliative Care Institute of the Brookdale, Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York City, USA.

Grants: K23AG025933 (Agency:United States NIA) ; K24AG22345 (Agency:United States NIA) ; R25 92055 (Agency:United States PHS)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: 2008-Sep; vol 168 (issue 16) : pp 1733-9

Dates: Created 2008/09/09; Completed 2008/10/03;

PMID: 18779459, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

These are the highest related articles currently in the database:

See 100+ related articles.