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decision making

Notes: - psychosocial stress can impair decision making [3] - in cases of multiple comorbidities, the time horizon for benefit from additional treatment (chemotherapy) is most useful to patients [4] - if patient refuses medical recommendations, ask why (even if it seems unlikely you will get a coherent response) [4] - refusal of treatment is the beginning of a conversation that can provide additional means to assess the patient's decisional capacity for informed refusal [4]

Related

ageism decision decision-making capacity; decisional capacity medical ethics paternalism surrogate decision maker (proxy)

Specific

shared decision making; patient preferecnce

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012
  2. Braddock CH 3rd, Edwards KA, Hasenberg NM et al Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999 Dec 22-29;282(24):2313-20. PMID: 10612318
  3. Lenow JK et al. Chronic and acute stress promote overexploitation in serial decision making. J Neurosci 2017 Jun 7; 37:5681 PMID: 28483979 http://www.jneurosci.org/content/37/23/5681
  4. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  5. Boyd C, Smith CD, Masoudi FA et al. Decision Making for Older Adults with Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2019;67(4):665-673 PMID: 30663782 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.15809