Decision making

Approaching discussions

The palliative care expert says
Dr. Tara Tucker discusses shared decision making. (3:22)Video transcript

Navigating discussions about the goals of care with the patient and family requires patience and skill.

Factors affecting decision-making

Helping families through the decision-making process can be challenging, especially if the patient isn’t conscious and their wishes aren’t known. Decisions that may seem straightforward to you may be layered with emotion, family history, and fear of making a mistake for family members, who may also be coming to terms with the patient's impending death. The wishes and reactions of a family may stem from caregiver exhaustion and concern for the dying person. The situation can be further complicated when family members aren’t on the same page.

Take the time it takes

  • Take the time to listen carefully to the patient and family.
  • You may need to revisit these conversations more than once to give the family time to understand and arrive at a decision.
  • Speak slowly, honestly and with great patience.
  • Take many pauses to let the family process the information.
  • Ask them to explain what you’ve said so you’re certain your words have been heard and understood.
  • Remember that decisions about care are emotionally loaded and sometimes lead to disagreement. (See the following sections.) 
  • Know that even with your best efforts, there is no guarantee that the patient or family will follow your recommendations.

Consultation

It may be helpful to consult with other health care providers. There are differing policies and procedures across jurisdictions that provide direction as to who you should contact for consultation. Ensure that you're familiar with your community guidelines.


Conversation Prompts

I know this is a difficult time. You and I are on the same team. We both share the same responsibility: to support the decision your son  has already made. We need to be together on this.