Decision making

In summary

The single biggest problem in communication is the illusion that it has taken place.   George Bernard Shaw

On many calls, you will enter a home knowing little other than someone needs your assistance urgently. It may feel like navigating a minefield blindfolded. You will be treading carefully as you work with patients and families facing challenging, frightening, and painful issues and emotional truths.

Paramedic intervention in a palliative care situation is a process of shared decision-making. You will be managing collaboration, negotiation, and reality. Reaching a realistic decision may take time. 

It is not always possible to avoid disagreement. The goal is not to avoid disagreement, but to work through it or, in some cases, find a way to repair a breakdown.

Keep in mind that it means a lot to families that you are trying and that you care.

Be mindful of inadvertently shaming the family by assuming a power position or telling them what is best for them. If they feel personally insufficient or foolish it will create defensiveness. Respect the family's authority and they will respect yours.

Creating a safe environment, finding a conversational pace, respecting silence, attending to subtle cues, and constructively breaking bad news – all of these can all go a long way in alleviating patient and family distress.