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Palliative Care - Decision Making

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Case:
A patient, who is diagnosed with terminal lung cancer, is being evaluated for palliative care. The client and her family are discussing options for care with the health care team, but it is apparent that there is little realistic understanding about the likelihood of the various alternatives for care. The patient is capable of making her own decisions about the level of terminal care she desires.

Questions:
Consider the Naturalistic Decision Making Theory below and apply it to the case study above to enhance the patient's and her family's decision making process.

Naturalistic decision making (NDM) refers to decision making as it occurs in real-time situations, especially those where stakes are high, decision problems are ill structured, conditions are stressful (e.g., time pressured), and the decision makers are highly experienced. NDM broadens the focus of decision-making research from the decision event to the larger processes of situation assessment. NDM approach to understanding decision making is realistic and pragmatic. The NDM theorists suggest the classic decision making theory that includes the (SEUT) theory have done little to assist our understanding of decision making in real world context (Scheider & Santeau, 2003). Zsambok and Klein (1997) noted that NDM could be identified as the study of how people use their personal experiences to make decisions in field settings. NDM models typically emphasize different cognitive strategies and processes used in particular decision situations (Burns, 2000) . Thus, decision-making is an evolving and dynamic process. Further, NDM emphasizes human decision-making competence rather than dysfunction. The three core variables of the NDM model are the decision task (i.e., the nature of the decision, for example the confidence or consequence); decision maker (i.e., factors internal to the performer, such as motivation and knowledge); and environment(i.e., the context in which the decision occurs). A major concept within NDM is the idea of situation awareness that requires the decision-maker to understand the context within which the decision problem is embedded and to use environmental cues to determine choice.

Consider Mrs. J refer to http://ccn.aacnjournals.org/content/25/6/28.long, who can no longer make a decision about her care, and designated her daughter to be her decision maker.

a. What are some of barriers to providing end of life care in the intensive care units?
b. List some steps commonly encountered in end of life decision-making by the family in an ICU setting.
c. Lastly, in your opinin what could have been done to make Mrs. J's last days better for her and her family?

Click on https://www.healthwise.net/cochranedecisionaid/Content/StdDocument.aspx?DOCHWID=tu1430 and summarize the evaluation of it based on the following criteria:

a. Is there a clear and understandable presentation of decision alternatives?
b. To what degree is there interactivity that allows the client and/or their family to engage fully in the decision process?
c. Does it help to clarify the risk inherent in the choice alternatives that must be presented to the client and/or family?
d. Does it help to reduce conflict?

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Solution Preview

Consider Mrs. J refer to http://ccn.aacnjournals.org/content/25/6/28.long, who can no longer make a decision about her care, and designated her daughter to be her decision maker.

a) What are some of barriers to providing end of life care in the intensive care units?

Some of the barriers in providing end of life care are physician attitudes, technology, and complexity of health care settings. Physicians often believe that because they possess expert knowledge about a patient's condition, their opinions should carry more weight than others. Many new forms of technology help health care professionals deliver services, help maintain patients' conditions, and can even cure some medical conditions. However, the technologies available do not often consider the patient's needs on a deeper level. The patient may not want to endure advanced treatments or may wish to enjoy the end of his or her life without all the technologies available. Often the patient's wishes are not the first concern. Even when advanced directives are completed prior to facing end of life health issues they are often ignored by providers.

b) List some steps commonly encountered in end of life decision-making by the family in an ICU setting.

The steps a family usually encounters in end of life decision making are:
1. Consultation with physicians about the family member's condition, listening to recommendations, considering options (including the wishes of the patient), and gathering information to make an informed or education decision.
2. Reviewing the patient's life through memories and bringing closure by considering what the patient would want.
3. Taking on the role as decision maker in end ...

Solution Summary

The solution discusses decision making in palliative care.

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Patients' Mental Capacity to Make Decisions

I need to identify an ethical issue from a volunteering experience in a hospital and:
1) Identify 10 relevant significant peer reviewed papers
2) Do a critical analysis of each paper
3) Synthesizing their various ideas into a coherent discussion/argument.
(In addition to the 10 papers, other sources may be used if necessary)

I will then use these ideas and relate them to the specific case I have chosen: a man with brain cancer. He has about a month to live, he is alert and able to communicate but as the cancer has spread his personality has changed from a previous visit a few weeks ago. He appears confused and incoherent at times. He has no family and lives alone at home. He's refusing to be admitted to a hospital to receive the end of life care he requires.

The broader topic I would like to write about is his mental capacity to make decisions about his treatment, give consent, etc. Under what circumstances would he be deemed to be able to act in his best interests, who makes the calls if he has no immediate family, what are the responsibilities and limitations of his doctors?

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