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What are common factors that can lead to misunderstanding of the dx/ prognosis?
- Doesn't understand or is even aware of dx
- Too much jargon
- Different or conflicting information
- Previous optimistic prognosis
- Stressful environment
- Sleep deprivation
- Emotional distress
- Psychologically unprepared
- Inadequate cognitive ability
How do you communicate and negotiate to resolve misunderstanding and conflict directly?
- Choose a 1° communicator, but provide access to all team members
- Give info in small pieces, multiple formats
- Use understandable language and avoid medical jargon
- Frequent repetition may be required
- Assess understanding frequently
- Do not hedge to "provide hope"
- Encourage writing down questions
- Provide support
- Involve other health care professionals as soon as possible - ie. social worker, chaplain, etc.
What is the due process approach to futility?
- Earnest attempts in advance - talk to pts before they undergo tx
- Joint decision making
- Negotiation of disagreements
- Involvement of an institutional committee
- Transfer to another physician
- Transfer to another facility
In futility conflicts, what are there disagreements over?
In futility conflicts, what are the differences in values of?
- Value of life
Whatever the conflict is, it is important to what?
Reaffirm the values and desirers of the patient
What are Younger's 4 Criteria?
(Used to support a claim that tx is futile)
- That the pt will have a poor quality of life
- That the tx is physiologically ineffective
- That although partially effective, the tx cannot cure the underlying illness and will only postpone death
- That the tx has an extremely low probability of being successful