Hope - Holy Cross Hospital

Impact of Hope on Decision-Making inthe ICU“Titrating Guidance”• Clinician’s role in decision-making adapts over time to changes inthe patients state of health based on likelihood of recovery.• Five steps:1) Determine where (predictability of outcome/acceptable QOL)the patient is in the ICU.2) Identify the cognitive and emotional factors and preferences foroutcomes that affect the decision-making process of thepatient/family.3) Reflect on your own cognitive and emotional reaction todecisions.4) Acknowledge how these factors can be addressed inconversation.5) GUIDE the patient/family in creating a plan.Goldstein NE, Back AL, Morrison RS,Titrating Guidance: A Model to Guide Physicians in Assisting Patients and Family MembersWho are Facing Complex Decisions. Arch Intern Med (2008); 168(16): 1733-1739