scholarly journals Do-(Not-)Mechanical-Circulatory-Support Orders: Should We Ask All Cardiac Surgery Patients for Informed Consent for Post-Cardiotomy Extracorporeal Life Circulatory Support?

2021 ◽  
Vol 10 (3) ◽  
pp. 383
Author(s):  
Jorik Simons ◽  
Martje Suverein ◽  
Walther van Mook ◽  
Kadir Caliskan ◽  
Osama Soliman ◽  
...  
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Mechanical Circulatory Support ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Circulatory Support ◽  
High Morbidity ◽  
Shared Decision ◽  
Starting Point

Post-cardiotomy extracorporeal life support (PC-ECLS) has seen a substantial increase in use over the past 10 years. PC-ECLS can be a life-saving procedure and is mostly applied in the presence of unexpected, severe cardio-respiratory complication. Despite PC-ECLS being critical in allowing for organ recovery, it is unfortunately closely connected with an unpredictable outcomes, high morbidity, and, even in the case of cardiac function improvement, potential sustained disabilities that have a life-changing impact for the patient and his or her family. Since the decision to start PC-ECLS is made in an acute setting, there is often only limited or no time for self-determined choices. Due to the major impact of the intervention, it would be highly desirable to obtain informed consent before starting PC-ECLS, since the autonomy of the patient and shared-decision making are two of the most important ethical values in modern medicine. Recent developments regarding awareness of the impacts of a prolonged intensive care stay make this a particularly relevant topic. Therefore, it would be desirable to develop a structural strategy that takes into account the likelihood of such an intervention and the wishes and preferences of the patient, and thus the related autonomy of the patient. This article proposes key points for such a strategy in the form of a PC-ECLS informed consent, a do-(not-)mechanical-circulatory-support order (D(N)MCS), and specific guidelines to determine the extent of the shared decision making. The concept presented in this article could be a starting point for improved and ethical PC-ECLS treatment and application.

Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law

2017 ◽  
Vol 45 (1) ◽  
pp. 12-40 ◽  
Author(s):  
Thaddeus Mason Pope
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Legal Doctrine ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Decision Making Processes

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

Das präoperative anästhesiologische Patientengespräch

2009 ◽  
Vol 66 (7) ◽  
pp. 503-508 ◽  
Author(s):  
Christoph Harms ◽  
Christoph H. Kindler
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision

Anästhesisten treffen ihre Patienten häufig in Ausnahmesituationen an, geprägt von Angst und großer Unsicherheit. Selbst zeitlich kurze Kontakte sind daher meist intensiv und bedeutsam. Das persönliche, anästhesiologische Gespräch steht am Beginn der Beziehung von Patient und Anästhesist und soll die geplanten Maßnahmen, welche der Anästhesist durchführen wird, erklären und begleiten. Ein solches Gespräch dauert heute durchschnittlich 20 Minuten. Es beinhaltet die Erhebung der Anamnese, die strukturierte und verständliche Informationsübermittlung zwischen Anästhesist und Patient (inklusive Informationen über die anästhesiologischen Interventionen, Instruktionen zum Verhalten des Patienten und die offene und klare Kommunikation von Vor- und Nachteilen sowie Risiken möglicher Anästhesieverfahren) sowie den professionellen Umgang mit den Emotionen des Patienten, insbesondere seiner präoperativen Angst. Da Patienten heute in der Anästhesiologie vermehrt in den Entscheidungsprozess mit einbezogen werden, entwickelt sich dieses Gespräch zunehmend von einer eher paternalistischen Arzt-Patienten Interaktion zu einer gemeinsamen Entscheidungsfindung, dem so genannten „shared decision making“. Formal sollte das präoperative Gespräch die bekannten Voraussetzungen für eine erfolgreiche Verständigung zwischen Patient und Arzt wie Deutlichkeit, Eindeutigkeit, identische Kodierung, Empathie und Rückmeldung erfüllen und mit dem einholen eines „informed consent“ enden.

scholarly journals Principles for screening: Too few concerns for informed consent and shared decision-making?

2018 ◽  
Vol 190 (37) ◽  
pp. E1115-E1115 ◽  
Author(s):  
Alain Braillon ◽  
Philippe Nicot ◽  
Cécile Bour
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision

Measuring Informed Consent and Shared Decision Making: A Quantitative Analysis

2016 ◽  
Vol 223 (4) ◽  
pp. e16
Author(s):  
Susan C. Pitt ◽  
Angela M. Ingraham ◽  
Megan C. Saucke ◽  
Elizabeth M. Wendt ◽  
Courtney J. Balentine ◽  
...  
Keyword(s):  
Decision Making ◽  
Quantitative Analysis ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision

scholarly journals Recommendations for the Care of Patients Receiving Conservative Kidney Management

2019 ◽  
Vol 14 (4) ◽  
pp. 626-634 ◽  
Author(s):  
Sara N. Davison ◽  
Beth Tupala ◽  
Betty Ann Wasylynuk ◽  
Valerie Siu ◽  
Aynharan Sinnarajah ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Professionals ◽  
Psychosocial Support ◽  
Symptom Burden ◽  
Shared Decision ◽  
Appropriate Treatment ◽  
Starting Point ◽  
Advance Care ◽  
Management Priorities

Conservative kidney management is increasingly accepted as an appropriate treatment option for patients with eGFR category 5 CKD who are unlikely to benefit from dialysis and/or who choose a nondialysis care option. However, there remains great variation in the delivery of their care. As part of the development of a conservative kidney management pathway that is undergoing evaluation, a set of recommendations specific to conservative kidney management for managing the complications of CKD and common symptoms was developed. These recommendations focus on the patient’s values and preferences and aim to optimize comfort and quality of life. Explanations for the interventions are provided to support the shared decision-making process between health care professionals, patients, and family members. The recommendations generally emphasize the preservation of function (cognitive, physical, and kidney) and address symptom burden, acknowledging that management priorities can change over time. The recommendations should be used in conjunction with other key elements of conservative kidney management, including clear communication and shared decision making for choosing conservative kidney management, advance care planning, and psychosocial support. Although there are limitations to the existing evidence specific to conservative kidney management, these recommendations are intended as a starting point toward reaching consensus and generating further evidence.

scholarly journals From informed consent to shared decision-making

2014 ◽  
Vol 104 (8) ◽  
pp. 561 ◽  
Author(s):  
Howard Manyonga ◽  
Graham Howarth ◽  
Mark Dinwoodie ◽  
Paul Nisselle ◽  
Sarah Whitehouse
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision

On shared decision-making and informed consent

2020 ◽  
pp. 10.1212/CPJ.0000000000000823
Author(s):  
James L. Bernat ◽  
Michael P. McQuillen
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision
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