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Differential diagnosis for disagreements between health care providers and families

Differential diagnosis for disagreements between health care providers and families
Major Reason Etiology Response
Misunderstanding Not informed Give information simply and in small chunks; check in frequently; use visual aids if possible
Given different information Bring providers together and give consistent information
Affective reasons Stress interferes with understanding Support family; give information again
Denial Attend to emotions
Guilt Attend to emotions; ask what patient wants
Lack of trust Acknowledge; negotiate plan
Other Following patient's wishes Ethics consultation
Secondary gain Confirm facts; ethics consultation
Hope for a miracle Religious support
Weighs patient attributes more than physician prediction Explore and try to understand reasoning behind family decisions 
Conflict persists   Second opinion; ethics or palliative care consultation
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