Determining factors for making complex decisions in patients with advanced chronic diseases

A palliative care perspective

Abstract

Decision making is a challenge faced by physicians in clinical practice. It requires a profound analysis of all the different factors which may influence the choice of treatment or diagnostic interventions. Factors related to the patients and their environment, the availability of resources, the clinician, and the proper handling of care in formation. The decision-making process becomes more complex in patients with advanced diseases or in the final stage of life, and requires a comprehensive approach by a professional trained in the communication process and in an empathic doctor-patient relationship which allows the participation of the patients and their families, as well as an acknowledgement of their wishes. It is imperative to engage in discussions regarding the prognosis, terminality and therapeutic goals, which are determining factors in this process and are discussed in this review