Informed Consent, Advance Directives, and Shared Care Planning [BOOK CHAPTER]

Informed Consent, Advance Directives, and Shared Care Planning [BOOK CHAPTER]
Giuseppe Renato Gristina
Palliative Care in Cardiac Intensive Care Units, 30 September 2021; pp 83-97 [Springer]
Abstract
Knowing patient wishes regarding treatment acceptance or refusal is an essential aspect of care strategy, based on the principle of autonomy. In clinical practice, ignoring patient wishes or not taking them into proper consideration can lead to ethical and legal issues. In most cases patients hospitalized in general or specialized intensive care units (e.g., ICUs or cardiac intensive care units—CICUs), are unable to make autonomous decisions regarding their treatment due to disease severity. As a consequence, advance directives (ADs) could be a particularly effective tool to adequately guide doctor conduct with respect to patient values and wishes. In the USA and in many European countries, ADs have now been integrated in their legal systems but, despite their popularity, ADs have not yet achieved the expected result. In contrast, shared care planning (SCP) has been more successful. SCP is the process by which the quality of future patient care is discussed and planned according to the patient’s values and preferences. Planning involves the patient, the healthcare professionals, and the family members. On one hand SCP can improve planning of future care for patients with advanced cardiovascular disease and document their preferences; on the other hand, it is unclear what role SCP has in improving the quality of patient life, reducing depression often associated with the disease, and increasing the caregiver satisfaction.