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Recently, I was asked to see a woman in her 80s for a goals-of-care discussion in a cardiovascular intensive care unit. She had experienced a myocardial infarction and had been offered coronary artery bypass grafting. In addition to her coronary artery disease, she had chronic kidney disease and type 2 diabetes mellitus. The consulting cardiovascular surgeon had quoted her a 20% perioperative risk of death. She was unsure how to proceed. As a palliative care consultant, I would help guide her forward using a shared decision-making model.
Mansel JK. The Diagnostic and Healing Qualities of StoryGoals of Care. JAMA Intern Med. 2014;174(7):1037. doi:10.1001/jamainternmed.2014.1800