DECISION-MAKING PEARLS
51 NB: These Reference Cards do not replace careful clinical judgment specific to each patient / family situation. PCIC: Palliative Care Interdisciplinary Curriculum is a collaborative effort of OhioHealth, The Ohio State University Wexner Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio, USA, and other contributors. Permission to reproduce any or all of these PCIC Reference Cards is granted for non-commercial educational purposes only, provided that the attribution statement and copyright are displayed. To reproduce for all other purposes, contact Frank D. Ferris at info@pallmed.us. Copyright © Frank D Ferris 2013-2024. All rights reserved. V14.1, 2024 1.Hope for the best 2.Plan for the worst 3.Plan for the catastrophic unexpected. Review the patient’s situation, goals and plans for life/care regularly. Adapted from S.P.I.K.E.S. Baile WE, Buckman R, Lenzi R et al. Oncologist 2000. PMID 10964998. And from www.VitalTalk.com. Used with permission. 6 STEPS TO NEGOTIATE GOALS OF CARE 1. S ETTING ‒Gather all important family members. Private. Be prepared. Sit down. Have tissues, water. Use a professional translator whenever necessary. Do not ask family to translate. 2. P ERCEPTION ‒What do the patient and family know? Correct any misperceptions. “Given the situation and prognosis, what are your goals for life and care?” “How do you typically make decisions in your family?” 3. I NVITATION ‒“Would you like to make decisions independently, or with your family?” “Would you prefer someone else makes decisions for you?” 4. K NOWLEDGE ‒Discuss 2 -3 treatment options most appropriate for the patient’s situation, including potential benefits, risks and burdens. Reassure family that you want to provide the best possible care. Always offer palliative care. 5. E MOTION ‒Use NURSE to Respond to Emotion. Give time to consider treatment options. May take hours to days. 6. S UBSEQUENT ‒Establish 3 plans for care:
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