June 5th, 2012 at 8:41 am
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Shared decision making helps elder discuss quality vs. quantity of life

by Dorian Martin

Many health care decisions come down to quality vs. quantity. Does the elder want to live a longer life, even if he or she is hooked up to a machine? Or does the elder opt for quality of life? If so, he or she may have to make some hard decisions when a critical medical issue arises.

Unfortunately, many elders aren’t really weighing the ramifications of their decisions when faced with deteriorating health.  That’s where new advice published by the American Heart Association (AHA) and endorsed by other medical groups comes in.

Shared decision making for elders

The AHA is now calling for doctors to engage patients in shared decision making. “Shared decision making asks that clinicians and patients share information with each other and work toward decisions about treatment that are aligned with patients’ values, goals, and preferences and are feasible given existing medical evidence,” the authors of the AHA paper, Executive Summary: Decision Making in Advanced Heart Failure, wrote. The association is urging doctors to help individual patients who have advanced heart failure develop realistic expectations, including the need for repeat hospitalizations as well as decreased effectiveness of treatment regimens as their health issue worsens.

AHA also is advocating that an annual heart failure review be conducted between the doctor and patient. This discussion would focus on current and potential therapies for unanticipated as well as anticipated events, such as cardiac and respiratory arrest. This conversation would allow the patient to make decisions based not only on this knowledge, but also on the patient’s values, goals and preferences.

Additionally, the association is recommending that doctors have a more focused conversation after milestones such as hospitalizations, defibrillator shocks, or limitations in functional capacity and independence. “Discussions should include a range of anticipated outcomes, including not only survival but also major adverse events, quality of life, symptom burden, functional limitations, loss of independence, and obligations for caregivers,” the AHA paper’s authors wrote. In addition, doctors should consider involving a palliative care team to assist with decision making and symptom management.

I appreciate that the AHA is encouraging these types of conversations between doctors and their patients. By understanding the ramifications of medical decisions, elders can make the proper choice that will help them live their life in the way that they want.

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