Ethics and Environmental Health

Overview of the Guide

WHAT IS THE PATIENT AND FAMILY DECISION-MAKING GUIDE? (Download the form here.)

The Chart Form is a tool that helps patients, family members and healthcare providers identify and discuss their concerns in a systematic way when complicated healthcare decisions need to be made.

• Helps identify and explain medical indications and treatment options

• Provides an opportunity for shared agreement about the treatment goals

WHY WAS THE PATIENT AND FAMILY DECISION-MAKING GUIDE CREATED?

The sections of this chart reflect the findings from nine different studies conducted in rural communities. This form is an attempt to respond to issues that, according to patients and healthcare providers occur with a high degree of frequency in rural healthcare settings. They include the following:

• Most rural physicians believe that patients frequently fail to understand diagnosis and treatment
  Most rural nurses reported, as their most common problem, that orders for patients are unclear or confusing
• Nurses and physicians have different perceptions of their roles on the healthcare teams
  Nurses expressed reluctance to discuss problematic issues with patients, noting they lack the words to initiate conversations
• Patients and family members say they rely on healthcare providers to explain options and guide the decision-making process

• Between 75-90% of rural healthcare providers want practical resources to help them deal with ethics-related issues.

WHEN MIGHT THIS GUIDE  BE USED?

This form is not meant to replace other forms such as consent forms and advance directives. But it may clarify areas of confusion and help patients prepare for necessary decisions. Clarification is important, given that:

• Patients have suggested that they often do not understand the implications of treatment decisions involving procedures like CPR, and artificial hydration and nutrition.
• Healthcare providers have questioned how much clinical detail should be provided when explaining medical procedures.

• Given the Institute of Medicine's Report To Err is Human, effective communication with patients seems particularly important.

HOW MIGHT THIS GUIDE BE USED?

Healthcare providers have suggested that this form might be used in a team setting. It could be used to first help healthcare providers identify areas of potential concern, and then offer a systematic way to share those concerns with patients and families.