scholarly journals P140: Emergency department decision-making for incapacitated and unrepresented patients: a comprehensive review of the literature

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S124-S125
Author(s):  
J.L. Willinsky ◽  
I. Hyun
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Medical Decision Making ◽  
Hospital Setting ◽  
Ethics Committees ◽  
Medical Decision ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Patient Cohort ◽  
Decision Making Processes

Introduction: Incapacitated patients who lack substitute decision-makers (SDM) are commonly encountered in the emergency department (ED). The number of these patients will rise dramatically as the Baby Boomers age. We can expect an influx of elderly patients who lack decisional capacity due to dementia and other illnesses, and who present without family. It is estimated that 3 to 4 percent of U.S. nursing home residents have no SDM or advance directives. Medical decision-making for this cohort poses an ethical challenge, particularly in the ED setting. Methods: A comprehensive review of the literature was conducted surrounding decision-making for incapacitated and unrepresented patients in the hospital setting. Articles were identified using MEDLINE (1946-October 2015) and Embase (1974-October 2015). The reference lists of relevant articles were hand searched. Articles describing decision-making processes that have been proposed, tested or applied in practice were chosen for full review. The aim of this review was to outline recognized medical decision-making processes for incapacitated and unrepresented patients, and to identify areas for future research. Results: The search yielded 20 articles addressing decision-making for incapacitated and unrepresented patients in the hospital setting. All of these articles focus on the intensive care unit and other hospital wards; no literature on the ED setting was found. Five types of formal consulting bodies exist to assist physicians in applying the best interest standard for this patient cohort: internal hospital ethics committees, external ethics committees, public guardians, court-appointed guardians, or judges. The majority of decisions for these patients, however, are made informally by a single physician or by a healthcare team, although it is well recognized that this approach lacks appropriate safeguards. There is no consensus surrounding the optimal approach to decision-making in these cases, and as such there is significant inconsistency in how medical decisions are made for these patients. Conclusion: There are several articles describing decision-making processes for incapacitated and unrepresented patients, none of which focus on the ED. These processes are not practical for use in the ED. Further inquiry is needed into the most ethical and respectful method of decision-making for this patient cohort in the ED.

Errors in Surgical Neuropathology and the Influence of Cognitive Biases: The Psychology of Intelligence Analysis

2006 ◽  
Vol 130 (5) ◽  
pp. 613-616 ◽  
Author(s):  
Roger E. McLendon
Keyword(s):  
Decision Making ◽  
Cognitive Psychology ◽  
Medical Decision Making ◽  
Cognitive Biases ◽  
Correct Diagnosis ◽  
Data Sources ◽  
Medical Decision ◽  
Intelligence Analysis ◽  
First Impression ◽  
Decision Making Processes

Abstract Context.—A significant difficulty that pathologists encounter in arriving at a correct diagnosis is related to the way information from various sources is processed and assimilated in context. Objective.—These issues are addressed by the science of cognitive psychology. Although cognitive biases are the focus of a number of studies on medical decision making, few if any focus on the visual sciences. Data Sources.—A recent publication authored by Richards Heuer, Jr, The Psychology of Intelligence Analysis, directly addresses many of the cognitive biases faced by neuropathologists and anatomic pathologists in general. These biases include visual anticipation, first impression, and established mindsets and subconsciously influence our critical decision-making processes. Conclusions.—The book points out that while biases are an inherent property of cognition, the influence of such biases can be recognized and the effects blunted.

The framing effect in medical decision-making: a review of the literature

2013 ◽  
Vol 18 (6) ◽  
pp. 645-653 ◽  
Author(s):  
Jingjing Gong ◽  
Yan Zhang ◽  
Zheng Yang ◽  
Yonghua Huang ◽  
Jun Feng ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Framing Effect ◽  
Medical Decision ◽  
Review Of The Literature

Ethics Committees: Group Process Concerns and the Need for Research

1995 ◽  
Vol 4 (1) ◽  
pp. 83-91 ◽  
Author(s):  
Gregory J. Hayes
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Group Process ◽  
Medical Decision Making ◽  
Ethics Committees ◽  
Medical Decision ◽  
Careful Evaluation ◽  
Healthcare Facilities ◽  
Healthcare Decision Making ◽  
Regular Section

Few ethics committees were in place when the New Jersey Supreme Court announced its ruling on the Quinlan case in 1976. Today, the vast majority of hospitals have formed ethics committees and their use in nursing homes and other healthcare facilities is growing. Given the increasing commitment to the use of ethics committees and their increasing influence on healthcare decision making, the careful evaluation of committee performance should be a high priority. Yet to date ethics committees appear to have undergone relatively little scrutiny. While professional articles on ethics committees do appear and at least one journal (CQ) sets aside a regular section for the discussion of “Ethics Committees at Work” articles to date have primarily been limited to essays, philosophical inquiries, reports, case studies, and, occasionally, surveys. The use of more structured research methodologies has been lacking. As a result, it is not yet clear, for example, what characteristics describe the best functioning ethics committee. Indeed, what constitutes best functioning lacks careful definition as well. Committee impact on medical decision making and patient outcomes, while discussed, has not been systematically measured and analyzed.

The Effect of Social Media on End-of-Life Decision Making

2014 ◽  
Author(s):  
Jessica Berg
Keyword(s):  
Decision Making ◽  
Social Media ◽  
End Of Life ◽  
Virtual Worlds ◽  
Medical Decision Making ◽  
Ethics Committees ◽  
Legal Framework ◽  
Medical Decision ◽  
Online Forums ◽  
Use Of Social Media

This article explores the ethical and legal issues involved in the use of social media to make end-of-life decisions. After providing an overview of social media such as online forums, virtual worlds, blogs, and social network sites, it considers the many different ways that social media might play a role in medical decision making. It then looks at the current legal framework for surrogate decision making and the concerns arising from the use of social media in such an endeavor. The article concludes by stressing the role of clinicians and ethics committees in helping surrogates navigate the complexities of medical decision making in the Internet age.

scholarly journals Understanding the Role of Numeracy in Health: Proposed Theoretical Framework and Practical Insights

2009 ◽  
Vol 36 (6) ◽  
pp. 1065-1081 ◽  
Author(s):  
Isaac M. Lipkus ◽  
Ellen Peters
Keyword(s):  
Decision Making ◽  
Risk Communication ◽  
Medical Decision Making ◽  
Theoretical Framework ◽  
Medical Decision ◽  
Mathematical Concepts ◽  
Health Numeracy ◽  
Targeted Interventions ◽  
Decision Outcomes ◽  
Decision Making Processes

Numeracy—that is, how facile people are with mathematical concepts and their applications—is gaining importance in medical decision making and risk communication. This article proposes six critical functions of health numeracy. These functions are integrated into a theoretical framework on health numeracy that has implications for risk communication and medical decision-making processes. The authors examine practical underpinnings for targeted interventions aimed at improving such processes as a function of health numeracy. They hope that the proposed functions and theoretical framework will spur more research to determine how an understanding of health numeracy can lead to more effective communication and decision outcomes.

Sign in / Sign up

Export Citation Format

Share Document