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A framework for medical treatment decision-making

A framework for medical treatment decision-making. Dr Barbara Hayes email: Barbara.Hayes@nh.org.au 2018. CPR discussion. http://www.youtube.com/watch?v=BdXwex3FzHY. Medical treatment goals based on -. …then within those constraints …leading to a shared understanding.

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A framework for medical treatment decision-making

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  1. A framework for medical treatment decision-making Dr Barbara Hayes email: Barbara.Hayes@nh.org.au 2018

  2. CPR discussion http://www.youtube.com/watch?v=BdXwex3FzHY

  3. Medical treatment goals based on - …then within those constraints …leading to a shared understanding (i) A medical assessment & a medical decision about treatment and what is clinically feasible (ii) A decision-making discussion between clinician and patient +/- Support Person or others • (iii) A medical treatment plan including: - Overall medical treatment goals & +/- Specific emergency medical treatments / limitations

  4. Medical treatment goals based on - …then within those constraints …leading to a shared understanding (i) A medical assessment & a medical decision about treatment and what is clinically feasible ‘Everything’ (ii) A decision-making discussion between clinician and patient +/- Support Person or others • (iii) A medical treatment plan including: - Overall medical treatment goals & +/- Specific emergency medical treatments / limitations

  5. Medical treatment goals based on - …then within those constraints …leading to a shared understanding (i) A medical assessment & a medical decision about treatment and what is clinically feasible Apply relevant Instructional Directive or RTC (ii) A decision-making discussion between clinician and MTDM +/- Support Person or others Apply other ACP, known preferences & values • (iii) A medical treatment plan including: - Overall medical treatment goals & +/- Specific emergency medical treatments / limitations

  6. Medical treatment goals based on - …then within those constraints …leading to a shared understanding (i) A medical assessment & a medical decision about treatment and what is clinically feasible (ii) A decision-making discussion between clinician and patient +/- Support Person or others • (iii) A medical treatment plan including: - Overall medical treatment goals & +/- Specific emergency medical treatments / limitations ie. GOALS OF PATIENT CARE CPR / NFR

  7. Ref: Hayes, B. 2012. Internal Medicine Journal

  8. The person who has lost capacity ... and no Advance Care Plan

  9. Learning about the person The story… of the person and the illness experience • Establish the illness trajectory • How did they respond at significant points? • How have they been coping with the illness? • What is the worst part of the illness? • What matters most? • Have they said anything about this sort of situation? • What do they fear most? • What do they hope for?

  10. Learning about the family Families are often responding emotionally rather than cognitively • Acknowledge emotions and distress and fatigue • Acknowledge love and caring • It sounds like it has been really difficult recently …how are you coping / feeling?

  11. “Tell-me-more”

  12. A better CPR discussion http://www.youtube.com/watch?v=rifTBDgAzzg

  13. Clinical scenarios

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