Choosing wisely at the end of life: the crucial role of medical indication.

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State: Public
Version: Final published version
Serval ID
serval:BIB_87433B729308
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Choosing wisely at the end of life: the crucial role of medical indication.
Journal
Swiss medical weekly
Author(s)
Borasio G.D., Jox R.J.
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Publication state
Published
Issued date
2016
Peer-reviewed
Oui
Volume
146
Pages
w14369
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish

Abstract
At the end of life, several treatments are administered routinely that lack medical indication and may cause significant harm to patients. Examples include artificial hydration and oxygen therapy in the dying phase, as well as enteral nutrition in advanced dementia. Medical indication is defined as the appropriateness of a therapeutic or diagnostic measure in the patient's concrete clinical situation, in light of the best available evidence. The decision about the absence or presence of a medical indication is a core competence of physicians. They have no obligation to perform or even mention measures that are not indicated. The decision about medical indication is a clinical compound decision, composed of both a factual, evidence-based judgement and a value judgement, which should always be patient-centred. Acknowledging the crucial role of medical indication in clinical decision making in medicine generally and at the end of life specifically opens up ways of enhancing patient-physician communication by clarifying roles, responsibilities and competencies. This may facilitate preventing overtreatment, improving patient wellbeing, and realising the patients' goals of care.

Pubmed
Web of science
Open Access
Yes
Create date
25/11/2016 16:21
Last modification date
20/08/2019 15:46
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