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24 Cards in this Set
- Front
- Back
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What are treatments that patients have the right to refuse…
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Mechanical ventilation, artificial nutrition/hydration, dialysis, recurrent hospitilizations and more
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What is default position if patients cannot express their wishes..
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Aggressive curative care
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What are advance directives…
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Specific instructions to direct medical care if person unable to
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What percentage of patients have a written AD… do most who do have them discuss them with their physician…
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25%... no
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What are the two general categores of advance directives…
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Instructional directives (living will, POLST, DNR) and Designation of proxy decision maker (POA, undersigned surrogates)
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What are problems with living wills…
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Legally valid documents but often fail to capture important patient preferences and documented preferences may not be authentic representations of patients wishes
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What does a POLST do…
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Specifies which treatment options (resustictation, intub, etc) the patient would want and is transferable between hospitals and home
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What are indications for POLST…
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Multiple medical problems, life-limiting illness, recurrent admissions and discharge to facility
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What percent of patients who arrest survive discharge…
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15% and half of those who do have significant decline in functional status
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What are predictors of worse outcomes in people who arrest and survive…
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Metastatic cancer, sepsis, renal failure, hypotension preceding arrest, >70 yo with comorbidities
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What do studies show about surrogates ability to accurately state preferences of patient…
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Frequently unable to do so
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When are a POAs decisions not accepted…
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When not acting in good faith or decisions contradict directives from the patient that are so specific and direct as to be clear and convincing
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In absence of designated surrogate, Utah recognizes proxy decision makes in what order…
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1. Spouse (if not legally separated). 2. Parent of patient. 3. Adult child of patient or majority of children available upon good faith efforts. 4. other relative
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What are hospitals required to do with regards to advance directives…
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Advise patient that they have right to AD, inquire whether patients
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With regards to an AD, hospitals are required to:
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advise patients that they have right to AD, inquire whether patients have AD, follow AD to extent of law,. Ad is under communications under documents tab in powerchart
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When should AD be asked about…
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On admission
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Written directives should be clarified about what…
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Whether binding, weighty but not binding, or informative
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Decision making capacity is…
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Decision-specific, changes with time, assessed by knowledgable clinicians
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A patient with decision making capacity should be able to…
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Understand and process info related to treatment options and consequences and should be able to communicate choice. Document this
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How do surrogates work in decision making process in case of written directives…
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Complementary help, clarify and fill in gaps not specified
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Hierarchy of decision making with regard to medical treatment of incapacitated…
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1. patients known wishes 2. substituted judgment based on values, beliefs, and past statements/decisions of patient 3. best interest of patient
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Do Advance directives guide decisions even if not complying with all legal formalities…
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Yes
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How should life-sustaining treatments be presented to families or patients…
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Not as menu options but framed within realistic goals specific to patient
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Who should be consulted in situations where physician feels uncomfortable…
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Palliative care or ethics committee
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