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Decision making in Advanced Disease

Decision making in advanced disease is complex and challenging. Decisions are emotional and often have irreversible outcomes (e.g., death). For many, the desire to live longer is strong, but unrealistic, when faced with advanced illness, and goals must be realigned toward comfort and quality of life. Some medical interventions are invasive and detract from quality of life without lengthening life. Decision makers include professionals, patients, their families, and external parties (institutions, insurers, governments). These decision makers may have diverse goals, priorities, values, and cultural backgrounds, affecting their beliefs about care near the end of life. Prognostication and communication are critical to good decision making. In advanced disease, preferences for decision-making style are individual, often unstated, and change over the illness course. Advance directives involve decisions ...

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