Knowing Is (Only) Half the Battle
Authors: Aaron M. Tannenbaum, Scott D. Halpern
Journal: Annals of Internal Medicine (2019)

Editorials5 March 2019Knowing Is (Only) Half the BattleAaron M. Tannenbaum, MD and Scott D. Halpern, MD, PhDAaron M. Tannenbaum, MDPerelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.M.T., S.D.H.) and Scott D. Halpern, MD, PhDPerelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.M.T., S.D.H.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-3691 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Although a "high-quality medical decision" has no universally accepted definition (1), most would agree that, at a minimum, it reflects a choice that is medically feasible and intended to promote the values of the patient. Yet in the context of critical illness, meeting even this minimum standard is challenging because patients are often incapacitated, their prognoses are uncertain, and the decisions required are emotionally charged and highly consequential. Prevailing wisdom and professional society guidelines (2) suggest that a process-oriented benchmark for which to strive is deliberative shared decision making that promotes patient goals. However, we lack evidence on the utility ...References1. Hamilton JG, Lillie SE, Alden DL, Scherer L, Oser M, Rini C, et al. What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders. J Behav Med. 2017;40:52-68. [PMID: 27566316] doi:10.1007/s10865-016-9785-z CrossrefMedlineGoogle Scholar2. Kon AA, Davidson JE, Morrison W, Danis M, White DB; American College of Critical Care Medicine. Shared decision making in ICUs: an American College of Critical Care Medicine and American Thoracic Society policy statement. Crit Care Med. 2016;44:188-201. [PMID: 26509317] doi:10.1097/CCM.0000000000001396 CrossrefMedlineGoogle Scholar3. Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, et al; APPROPRICUS Study Group of the Ethics Section of the ESICM. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA. 2011;306:2694-703. [PMID: 22203538] doi:10.1001/jama.2011.1888 CrossrefMedlineGoogle Scholar4. Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:CD001431. [PMID: 28402085] doi:10.1002/14651858.CD001431.pub5 CrossrefMedlineGoogle Scholar5. Cox CE, White DB, Hough CL, Jones DM, Kahn JM, Olsen MK, et al. Effects of a personalized Web-based decision aid for surrogate decision makers of patients with prolonged mechanical ventilation. A randomized clinical trial. Ann Intern Med. 2019;170:285-97. doi:10.7326/M18-2335 LinkGoogle Scholar6. Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346:1061-6. [PMID: 11932474] CrossrefMedlineGoogle Scholar7. Rubin EB, Buehler AE, Halpern SD. States worse than death among hospitalized patients with serious illnesses. JAMA Intern Med. 2016;176:1557-9. [PMID: 27479808] doi:10.1001/jamainternmed.2016.4362 CrossrefMedlineGoogle Scholar8. Wilson TD, Schooler JW. Thinking too much: introspection can reduce the quality of preferences and decisions. J Pers Soc Psychol. 1991;60:181-92. [PMID: 2016668] CrossrefMedlineGoogle Scholar9. Mercier H, Sperber D. Why do humans reason? Arguments for an argumentative theory. Behav Brain Sci. 2011;34:57-74; discussion 74-111. [PMID: 21447233] doi:10.1017/S0140525X10000968 CrossrefMedlineGoogle Scholar10. Rubin EB, Buehler AE, Cooney E, Gabler NB, Mante A, Halpern SD. Intuitive versus deliberative approaches to making decisions about life support: a randomized trial. JAMA Netw Open. 2019;2. CrossrefGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.M.T., S.D.H.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3691.Corresponding Author: Aaron M. Tannenbaum, MD, University of Pennsylvania Perelman School of Medicine, Palliative and Advanced Illness Research (PAIR) Center, 300 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021; e-mail, aaron.[email protected]upenn.edu.Current Author Addresses: Dr. Tannenbaum: University of Pennsylvania Perelman School of Medicine, Palliative and Advanced Illness Research (PAIR) Center, 300 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021.Dr. Halpern: 301 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.This article was published at Annals.org on 29 January 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation Christopher E. Cox , Douglas B. White , Catherine L. Hough , Derek M. Jones , Jeremy M. Kahn , Maren K. Olsen , Carmen L. Lewis , Laura C. Hanson , and Shannon S. Carson Metrics Cited bySurrogate and Physician Decision Making for Mechanically Ventilated Patients According to Expected Patient OutcomeAdapting a Traumatic Brain Injury Goals-of-Care Decision Aid for Critically Ill Patients to Intracerebral Hemorrhage and Hemispheric Acute Ischemic StrokeDevelopment and usability testing of Understanding Stroke, a tailored life-sustaining treatment decision support tool for stroke surrogate decision makersGoals-of-care decision aid for critically ill patients with TBIConcerns of surrogate decision makers for patients with acute brain injury 5 March 2019Volume 170, Issue 5Page: 338-339KeywordsAlgorithmsDecision makingDisclosureEmotionsForecastingMotivationPatientsShouldersSurgical intensive care unitsVentilators ePublished: 29 January 2019 Issue Published: 5 March 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...