However, investigators were racially diverse and from different disciplines (medicine, social sciences, ethics), and each read transcripts independently before reaching consensus. Our data emphasize that seriously ill patients fell into five ethically and clinically distinct variants across race/ethnicity. Respect for patient autonomy requires recognition of and respect for these variants and the appropriate implementation strategies they ensue. Patients’ autonomy can be enhanced by encouraging patients to make

and effectively communicate their decisions, subject to the limitations on doing so posed by “Avoiders” whose preferred decision-making style may not allow clinicians to promote and assist in advance care planning. The physician’s goal should be to selleck chemical promote effective EOL decision-making with Autonomists, Altruists, Authorizers, Absolute Trusters, and Avoiders. No one this website size will fit all patients, whose implementation strategies may range from completing formal documents to increasing oral communication with surrogates. Physicians should judiciously allocate their time in a persistent, respectful, and supportive effort to engage patients in EOL care planning.

Patient-centered, culturally competent EOL decision-making is a powerful tool to ensure that patient preferences are truly upheld. Physicians have limited time to spend, requiring priorities to be set. Assisting Autonomists and Altruists to implement EOL decisions generally will be relatively simple: they

have made decisions and only need to effectively communicate them. Physicians can assist by providing appropriate Fludarabine research buy paperwork or, for patients uncomfortable with written documents, strongly encouraging patients to discuss their wishes in detail with their legal surrogate decision maker(s). Surrogates will then be able to report the already-made decision of the patient, a role that is perceived as less burdensome [32] and [33]. Physicians could also facilitate discussions with potential surrogates and clarify to patients who their legal surrogates are [34]. Assisting some Authorizers may be relatively straightforward but can sometimes, along with assisting Absolute Trusters, be considered complex. This is because Authorizers first need to make clearer general value statements before they can effectively communicate them. Absolute Trusters by definition let others decide about their care. They can be strongly encouraged to give more guidance to their surrogates, moving them to Authorizers or, if they want to reduce the decision-making burden on surrogates, Altruists. Often this can be accomplished simply by pointing out how hard it is to make such important decisions for someone else without any guidance by that person [31], [32], [33] and [35].