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 |