Abstract
In health care for older adults, patients with multimorbidity usually receive the same interventions as those patients without multimorbidity. However, standard curative or life-sustaining treatment options have to be considered carefully in view of the maximally attainable result in older and frail patients. To guide such complex medical decisions, we present a compact deliberation framework that could assist physician(s) in charge of the medical treatment of a specific elderly patient to systematize his own thinking about treatment and decisional responsibilities, in case of an intercurrent disease.The framework includes four questions to be addressed when deciding on a single urgent standard curative or life-sustaining intervention in acute medical problems of an elderly patient with multimorbidity: 1) What is known about the patient’s aims and preferences? 2) Will the intervention be effective? 3) Will the intervention support the aims and preferences of the patient? 4) In view of the aims and preferences, will the risks and benefits be in balance?If all four considerations are answered favorably, the intervention will fit patient-centered and appropriate care for frail older patients with multimorbidity.Application to a patient case illustrates how our framework can improve the quality of the shared decision-making process in care for older people and helps clarify medical and moral considerations regarding how to appropriately treat the individual patient.
Highlights
Mrs W., a 92-year-old widow with three daughters, has a medical history of myocardial infarction, cardiac failure, a total hip arthroplasty for osteoarthritis of her right hip, and dementia
We present a compact framework for deliberation by the physician that helps to clarify the core elements of the clinical ‘weighing process’, making explicit the different elements
Developed in nursing home medicine it is especially helpful when faced with an acute treatment decision for a single standard intervention in case of an intercurrent disease in the context of a patient with multimorbidity
Summary
Decision-making as to whether or not to treat a particular affliction is a complex matter, with a need to balance the medical considerations and the patient’s aims and wishes [1,2,3,4]. We present a compact framework for deliberation by the physician that helps to clarify the core elements of the clinical ‘weighing process’, making explicit the different elements. Developed in nursing home medicine it is especially helpful when faced with an acute treatment decision for a single standard intervention in case of an intercurrent disease in the context of a patient with multimorbidity. Thoroughly incorporating the patient’s perspective, the framework is not meant as a decision aid for physician-patient communication or as an alternative method for shared decision-making. Rather, it helps clarify and articulate the thinking process. The framework is presented and illustrated by analyzing a case from our practice in geriatric medicine
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