“I'd Recommend …” How to Incorporate Your Recommendation Into Shared Decision Making for Patients With Serious Illness

Abstract

Patients and families facing serious illness often want and need their clinicians to help guide medical decision making by offering a recommendation. Yet clinicians worry that recommendations are not compatible with shared decision making and feel reluctant to offer them. We describe an expert approach to formulating a recommendation using a shared decision-making framework. We offer three steps to formulating a recommendation: 1) evaluate the prognosis and treatment options; 2) understand the range of priorities that are important to your patient given the prognosis; and 3) base your recommendation on the patient's priorities most compatible with the likely prognosis and available treatment options.

The impact of a patient decision aid on shared decision‐making behaviour in oncology care and pulmonary medicine—A field study based on real‐life observations

“…Nevertheless, Jacobsen et al find that timing and content of the recommendation are more important than whether or not a recommendation is given. Patients sometimes ask for a recommendation, and if the clinician's recommendation is based on the patient's preferences, it can be helpful to the patient in being aware of what matters the most, which is congruent with the core elements of SDM. This is an area for further research and education of clinicians in SDM.…”

Nature of Discussions about Systemic Therapy Discontinuation or Hospice among Patients, Families, and Palliative Care Clinicians during Care for Incurable Cancer: A Qualitative Study

“…Prior work has proposed adaptations to shared decision making in serious illness (e.g., incorporating clinician recommendations). 29 Current findings further highlight the need to account for diverse points along the illness trajectory in which patients, families, and clinicians may address EOL care options in the context of both uncertainty and certain disease progression. Findings also highlight the importance of additional work to delineate the roles of oncology and palliative care clinicians in EOL care decision making along the disease trajectory.…”

Palliative Care for Patients With Advanced CKD: Moving Beyond the Status Quo

“…As a first step, we advocate using a model of shared decision making that conceptualizes the clinician as a guide in serious illness conversations and devotes particular attention to the pathway to attaining a goal-concordant recommendation. 14 Although there are other established communication techniques available, 15 this concise framework can help nephrology trainees learn not only to evaluate prognoses and available treatment options, but also to prioritize patients’ range of priorities in this context. 14 Nephrology training programs may also consider adapting innovative communication tools from other patient populations undergoing a major intervention to dialysis decision making in advanced CKD.…”

“… 14 Although there are other established communication techniques available, 15 this concise framework can help nephrology trainees learn not only to evaluate prognoses and available treatment options, but also to prioritize patients’ range of priorities in this context. 14 Nephrology training programs may also consider adapting innovative communication tools from other patient populations undergoing a major intervention to dialysis decision making in advanced CKD. For example, by re-formulating a semi-structured script originally developed for heart failure PreVAD evaluation (before left ventricular assist device [LVAD] implantation) and applying it to dialysis decision making, we may be better equipped to reflect on patient values and “unacceptable condition(s)” affecting treatment choices throughout the disease course ( Box 1 ).…”