Scenario Analysis: This scenario is professionally challenging because it requires balancing the potential benefits of innovation and data collection in neurohospitalist medicine with the stringent ethical and regulatory obligations concerning patient privacy, data security, and informed consent. The rapid pace of translational research and the increasing use of registries can create complex situations where the lines between research, quality improvement, and routine clinical care may blur, necessitating careful navigation of established guidelines. Correct Approach Analysis: The best professional approach involves establishing a clear, robust, and transparent framework for translational research and registry participation that prioritizes patient autonomy and data integrity. This includes obtaining explicit, informed consent from patients for the use of their de-identified data in translational research and registry initiatives, ensuring that the purpose and scope of data usage are clearly communicated. Furthermore, it necessitates adherence to all applicable data protection regulations, such as those governing health information privacy and security, and implementing strong anonymization and de-identification protocols before data is shared or utilized for research purposes. This approach aligns with the ethical principles of beneficence, non-maleficence, and respect for persons, and complies with regulatory requirements designed to protect patient rights and data confidentiality. Incorrect Approaches Analysis: One incorrect approach involves proceeding with the use of patient data for translational research and registry development without obtaining explicit consent, under the assumption that de-identification is sufficient. This fails to respect patient autonomy and may violate regulations that require specific consent for research use of health data, even if anonymized. The ethical failure lies in not providing individuals with the choice to participate in research activities. Another incorrect approach is to integrate patient data into a registry for quality improvement purposes without clearly delineating its potential future use in translational research, and without a mechanism for re-consent if the data’s application significantly expands beyond initial quality metrics. This can lead to a breach of trust and potential regulatory non-compliance if the registry’s scope evolves into something beyond its original stated purpose without further patient authorization. A third incorrect approach is to prioritize the speed of innovation and data aggregation over rigorous data security and privacy protocols. This could involve sharing data with external research partners without adequate vetting of their data handling practices or without robust contractual agreements in place to ensure data protection. This poses a significant risk of data breaches and violates regulatory mandates for safeguarding sensitive patient information. Professional Reasoning: Professionals in neurohospitalist medicine must adopt a proactive and ethically grounded approach to translational research and registry development. This involves establishing clear institutional policies and procedures that govern data use for research, ensuring comprehensive training for all staff on data privacy and consent requirements, and fostering a culture of ethical research conduct. When faced with opportunities for innovation, the decision-making process should always begin with an assessment of patient rights and regulatory obligations, followed by the development of transparent and consent-driven mechanisms for data utilization. Collaboration with institutional review boards (IRBs) or ethics committees is crucial for navigating complex research protocols and ensuring compliance.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between resource allocation decisions and the ethical imperative to provide optimal patient care. Neurohospitalists must balance the financial sustainability of their practice with their duty to their patients, particularly when faced with limited resources or the need to adopt new, potentially costly, technologies or treatment protocols. The pressure to maintain profitability can inadvertently lead to decisions that compromise patient outcomes or access to care, necessitating a robust ethical framework and a clear understanding of professional responsibilities. Correct Approach Analysis: The best professional approach involves a comprehensive evaluation that prioritizes patient well-being and evidence-based practice while also considering the long-term viability of the practice. This includes a thorough review of the clinical efficacy and safety of the proposed new diagnostic technology, its potential impact on patient outcomes, and its integration into existing workflows. Simultaneously, a realistic assessment of the financial implications, including implementation costs, ongoing maintenance, and reimbursement potential, is crucial. This approach ensures that decisions are grounded in both clinical excellence and responsible financial stewardship, aligning with the ethical obligations of healthcare professionals to act in the best interest of their patients and the community they serve. This aligns with the principles of professional conduct that emphasize patient welfare as paramount. Incorrect Approaches Analysis: Adopting the new technology solely based on its perceived prestige or competitive advantage, without a rigorous assessment of its clinical benefit and cost-effectiveness, is professionally unacceptable. This approach risks misallocating resources, potentially diverting funds from more critical patient needs or established, effective treatments. It also fails to uphold the principle of evidence-based medicine, which mandates that clinical decisions be informed by the best available scientific evidence. Implementing the new technology only if it demonstrably increases revenue, regardless of its impact on patient care or its necessity, is also professionally unsound. This prioritizes financial gain over patient well-being, violating the core ethical tenet of beneficence and potentially leading to the provision of unnecessary or suboptimal care. Such a focus can erode patient trust and compromise the integrity of the practice. Rejecting the new technology outright due to initial cost concerns, without a thorough investigation into its potential long-term benefits, improved patient outcomes, or potential for cost savings through earlier or more accurate diagnosis, is also a flawed approach. This can lead to missed opportunities to enhance patient care and maintain a competitive edge, potentially resulting in a decline in the quality of services offered over time. Professional Reasoning: Professionals should employ a structured decision-making process that begins with clearly defining the problem or opportunity. This involves gathering all relevant information, including clinical evidence, financial data, and operational considerations. Next, they should identify and evaluate all potential courses of action, weighing the benefits and drawbacks of each against established ethical principles and professional standards. This evaluation should include a risk-benefit analysis for patients and the practice. Finally, the chosen course of action should be implemented, monitored, and reviewed for its effectiveness and impact, allowing for adjustments as needed. This systematic approach ensures that decisions are well-informed, ethically sound, and aligned with the overarching goal of providing high-quality patient care.

Scenario Analysis: This scenario is professionally challenging because it requires a neurohospitalist to navigate the specific requirements and intent behind the Comprehensive Gulf Cooperative Neurohospitalist Medicine Practice Qualification. Misinterpreting the purpose or eligibility criteria can lead to wasted resources, professional disappointment, and potentially impact patient care if the qualification is a prerequisite for certain roles or advanced practice. Careful judgment is required to align the individual’s professional goals and experience with the stated objectives of the qualification. Correct Approach Analysis: The best approach involves a thorough review of the official documentation outlining the purpose and eligibility for the Comprehensive Gulf Cooperative Neurohospitalist Medicine Practice Qualification. This includes understanding the qualification’s aim in standardizing neurohospitalist practice across the Gulf Cooperative region, its intended scope (e.g., specific patient populations, types of neurological conditions managed), and the precise criteria for eligibility, such as required years of experience, specific training, board certifications, and any regional practice requirements. This direct engagement with the governing guidelines ensures accurate assessment and application. Incorrect Approaches Analysis: One incorrect approach is to rely solely on anecdotal information or the experiences of colleagues who have previously pursued similar qualifications. While collegial advice can be helpful, it may not reflect the most current or precise requirements of this specific qualification, leading to misunderstandings about eligibility or the qualification’s true purpose. This approach risks misinterpreting the intent and scope of the qualification. Another incorrect approach is to assume that general neurohospitalist experience is sufficient without verifying if it aligns with the specific nuances of the Gulf Cooperative region’s healthcare needs or the qualification’s focus on neurohospitalist medicine as defined by the governing body. This overlooks the possibility that the qualification may have specialized requirements beyond general practice, such as specific competencies in managing acute neurological emergencies prevalent in the region or adherence to particular treatment protocols. A further incorrect approach is to focus only on the perceived prestige or career advancement opportunities associated with the qualification without deeply understanding its core purpose and whether the individual’s current practice and future aspirations genuinely align with that purpose. This can lead to pursuing a qualification that, while prestigious, does not genuinely enhance the individual’s ability to contribute to the specific goals the qualification aims to achieve within the Gulf Cooperative neurohospitalist medicine landscape. Professional Reasoning: Professionals should adopt a systematic approach when evaluating qualifications. This involves: 1. Identifying the qualification and its issuing body. 2. Locating and meticulously reviewing all official documentation related to the qualification’s purpose, objectives, and eligibility criteria. 3. Comparing one’s own professional background, experience, and career goals against these documented requirements. 4. Seeking clarification from the issuing body if any aspects of the documentation are unclear. 5. Making an informed decision based on a clear understanding of the alignment between the individual and the qualification’s intent.

The evaluation methodology shows that assessing the neurohospitalist’s adherence to established clinical protocols for stroke management in a complex, time-sensitive emergency is paramount. This scenario is professionally challenging due to the critical nature of stroke, where rapid and accurate decision-making directly impacts patient outcomes and potential for long-term disability or mortality. The neurohospitalist must balance immediate patient needs with the systematic application of evidence-based guidelines, often under significant pressure and with incomplete information. The correct approach involves a comprehensive review of the patient’s presentation, diagnostic imaging, and the neurohospitalist’s documented interventions against the hospital’s approved stroke management protocol. This includes verifying timely administration of thrombolytic therapy (if indicated and within the time window), appropriate consultation with neurology and interventional radiology, and adherence to post-intervention monitoring guidelines. This approach is correct because it directly assesses the neurohospitalist’s performance against established standards of care, which are often mandated by regulatory bodies and hospital accreditation organizations to ensure patient safety and quality of care. Adherence to these protocols is a fundamental ethical and professional obligation, aiming to minimize harm and maximize benefit for patients experiencing acute neurological emergencies. An incorrect approach would be to solely focus on the patient’s eventual outcome without a thorough examination of the process. While a good outcome is desirable, it does not automatically validate the neurohospitalist’s actions if they deviated from or failed to implement critical protocol steps. This approach is flawed because it risks overlooking potential breaches in care that, while not resulting in immediate adverse events, could represent systemic issues or increased risk in future cases. Another incorrect approach would be to prioritize physician preference or anecdotal experience over documented hospital protocols. This is professionally unacceptable as it undermines the principle of evidence-based medicine and can lead to inconsistent or suboptimal care. Regulatory frameworks and ethical guidelines emphasize the importance of standardized, evidence-based practices to ensure equitable and high-quality care for all patients. A further incorrect approach would be to dismiss minor deviations from the protocol without considering their potential cumulative impact or the underlying reasons for the deviation. Even seemingly small departures can indicate a lack of understanding, resource limitations, or systemic inefficiencies that require attention. Professional decision-making in such situations requires a systematic evaluation of all documented actions against established protocols, a consideration of the clinical context, and a commitment to continuous quality improvement based on objective evidence.

This scenario presents a professional challenge due to the inherent tension between a hospital’s operational needs and the stringent requirements for maintaining accurate and compliant patient records, particularly in a specialized field like neurohospitalist medicine. The pressure to quickly onboard new staff and ensure immediate patient care can inadvertently lead to shortcuts that compromise data integrity and regulatory adherence. Careful judgment is required to balance efficiency with the non-negotiable standards of medical documentation and patient safety. The correct approach involves a systematic and documented verification process that aligns with the principles of good clinical practice and the implicit requirements of maintaining a qualified medical workforce. This includes ensuring that all necessary credentials, licenses, and certifications are not only presented but also independently verified against official sources before the physician is granted independent practice privileges. This proactive verification safeguards patient care by confirming the physician’s competence and adherence to professional standards, thereby mitigating risks associated with unqualified practitioners. It also ensures compliance with any governing body’s requirements for physician credentialing and privileging, which are fundamental to hospital accreditation and legal operation. An incorrect approach would be to rely solely on the physician’s self-attestation or the attestation of a previous employer without independent verification. This fails to meet the standard of due diligence expected in credentialing. It introduces a significant risk of employing a practitioner whose qualifications are misrepresented or have lapsed, potentially leading to substandard care and serious patient harm. Ethically, it breaches the duty of care owed to patients and professionally, it undermines the integrity of the hospital’s medical staff. Another incorrect approach is to grant provisional privileges based on the expectation that verification will be completed later, without clear, time-bound deadlines and robust oversight. While provisional privileges can be a necessary tool, they must be managed with extreme caution. If the verification process is not expedited and completed promptly, it creates a window of vulnerability where patient care could be compromised by an unverified practitioner. This approach prioritizes expediency over patient safety and regulatory compliance. A further incorrect approach is to delegate the entire verification process to the new physician’s direct supervisor without establishing a clear, independent verification protocol. While supervisors are responsible for the performance of their staff, the credentialing and privileging process is a distinct administrative and compliance function that requires a standardized, objective approach. Over-reliance on a supervisor’s informal assessment can lead to inconsistencies and a lack of thoroughness, potentially overlooking critical discrepancies in qualifications. The professional decision-making process for similar situations should involve a clear understanding of the hospital’s credentialing policy, relevant regulatory guidelines (such as those pertaining to medical staff credentialing and privileging), and ethical obligations to patient safety. This process should prioritize a structured, documented, and independently verifiable approach to credentialing, ensuring that all new physicians meet established standards before assuming patient care responsibilities. It requires a commitment to thoroughness, even under pressure, and a willingness to pause or delay privileges if verification cannot be completed to the required standard.

Scenario Analysis: This scenario is professionally challenging because it involves a physician seeking to understand the implications of a failed qualification exam on their career progression within the neurohospitalist specialty. The pressure to advance, coupled with the uncertainty of retake policies and potential impact on practice, requires careful navigation of the hospital’s internal quality control and qualification framework. Misinterpreting or circumventing these policies could lead to professional repercussions and compromise patient care standards. Correct Approach Analysis: The best professional approach involves proactively and formally engaging with the hospital’s credentialing and professional development departments to obtain clear, documented information regarding the blueprint weighting, scoring, and retake policies for the Comprehensive Gulf Cooperative Neurohospitalist Medicine Practice Qualification. This approach is correct because it adheres to established institutional procedures for managing qualification assessments. It ensures that the physician receives accurate information directly from the authoritative source, minimizing the risk of misinformation or misinterpretation. This aligns with ethical obligations to maintain professional competence and follow institutional guidelines, which are implicitly designed to uphold quality standards and patient safety. Documented communication also provides a record of the physician’s diligence and understanding of the process. Incorrect Approaches Analysis: One incorrect approach is to rely on informal discussions with colleagues or supervisors for information about retake policies. This is professionally unacceptable because informal advice may be inaccurate, outdated, or incomplete, leading to a misunderstanding of the official requirements. This could result in the physician taking actions that are not in compliance with the qualification framework, potentially jeopardizing their standing or ability to practice. Another incorrect approach is to assume that a single failed attempt automatically disqualifies a physician from future opportunities without seeking clarification. This demonstrates a lack of proactive engagement with the established processes and can lead to unnecessary professional anxiety and potentially missed opportunities if the policies allow for retakes under specific conditions. A third incorrect approach is to attempt to practice without fully understanding the implications of the failed qualification, hoping the issue will not be discovered. This is ethically and professionally reprehensible as it directly compromises patient safety by placing individuals in roles for which they have not met the required standards, violating the core principle of “do no harm.” Professional Reasoning: Professionals facing a similar situation should adopt a systematic approach. First, identify the relevant governing body or institution responsible for the qualification. Second, locate and thoroughly review all official documentation pertaining to the qualification, including weighting, scoring, and retake policies. Third, if any ambiguities remain, formally request clarification from the designated department or committee, ensuring the request is documented. Fourth, understand the implications of the qualification status on current and future practice. Finally, act in accordance with the established policies and seek guidance to ensure continued professional development and adherence to ethical standards.

Scenario Analysis: This scenario is professionally challenging because it requires a neurohospitalist candidate to balance the demands of a rigorous qualification process with their existing clinical responsibilities. The pressure to perform well on the Comprehensive Gulf Cooperative Neurohospitalist Medicine Practice Qualification, coupled with the need to maintain patient care standards, creates a significant time management and prioritization dilemma. Failure to adequately prepare can lead to suboptimal performance on the qualification, potentially impacting career progression and patient safety. Conversely, over-dedication to preparation at the expense of current duties could also compromise patient care. Careful judgment is required to identify resources and a timeline that are both effective for qualification preparation and sustainable within the context of active clinical practice. Correct Approach Analysis: The best professional approach involves a structured, proactive, and resource-informed preparation strategy. This includes identifying official qualification study guides and recommended reading lists provided by the Gulf Cooperative Council for Medical Specialties (GCCMS) or equivalent governing bodies. It also entails creating a realistic study schedule that integrates preparation sessions into the existing clinical workload, perhaps by dedicating specific hours each week or utilizing protected study time if available. Seeking guidance from mentors or colleagues who have successfully completed the qualification can provide invaluable insights into effective preparation methods and common pitfalls. This approach is correct because it aligns with the principles of professional development and lifelong learning mandated by medical practice standards, ensuring that preparation is thorough, evidence-based, and ethically sound, without compromising current patient care responsibilities. It prioritizes official guidance and realistic integration into practice. Incorrect Approaches Analysis: One incorrect approach involves relying solely on informal study groups and anecdotal advice from peers without consulting official qualification materials. This is professionally unacceptable because it risks missing crucial, officially sanctioned content and may lead to preparation based on outdated or inaccurate information, failing to meet the specific requirements of the qualification. Another incorrect approach is to defer all preparation until the final weeks leading up to the examination, cramming extensively without a structured plan. This is ethically problematic as it suggests a lack of commitment to thorough professional development and can lead to superficial learning, potentially impacting the quality of care provided by a neurohospitalist. It also increases the risk of burnout and stress, which can negatively affect performance. A third incorrect approach is to neglect current clinical duties to focus exclusively on qualification preparation. This is a severe ethical and professional failure, as a neurohospitalist’s primary responsibility is to their patients. Prioritizing personal qualification over patient well-being is a breach of the physician’s oath and professional obligations, and could lead to adverse patient outcomes and disciplinary action. Professional Reasoning: Professionals facing similar situations should employ a systematic decision-making process. First, thoroughly understand the qualification requirements by consulting official documentation. Second, conduct a realistic self-assessment of current time availability and identify potential study windows. Third, prioritize official resources and evidence-based preparation methods. Fourth, develop a phased study plan that integrates preparation with clinical duties, seeking mentorship where appropriate. Finally, continuously evaluate the effectiveness of the preparation strategy and make adjustments as needed, always ensuring that patient care remains the paramount concern.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate clinical needs of a patient with the ethical and regulatory obligations concerning the use of novel, unapproved treatments. The physician must navigate the potential benefits of an experimental therapy against the risks, the patient’s autonomy, and the established protocols for research and treatment within the neurohospitalist practice. Careful judgment is required to ensure patient safety, uphold ethical standards, and comply with relevant guidelines for experimental interventions. Correct Approach Analysis: The best professional practice involves a comprehensive, multi-faceted approach that prioritizes patient safety and informed consent while adhering to established ethical and regulatory frameworks. This includes thoroughly reviewing the existing scientific literature on the experimental therapy, consulting with relevant ethics committees and institutional review boards (IRBs) to ensure compliance with research protocols and patient protection, and engaging in a detailed, transparent discussion with the patient and their family about the experimental nature of the treatment, its potential benefits, risks, and alternatives. Obtaining explicit, informed consent is paramount. This approach aligns with fundamental ethical principles of beneficence, non-maleficence, and respect for autonomy, as well as regulatory requirements for the use of investigational drugs or treatments. Incorrect Approaches Analysis: Pursuing the experimental therapy without prior consultation with the ethics committee or IRB represents a significant regulatory and ethical failure. It bypasses essential oversight mechanisms designed to protect vulnerable patients and ensure the scientific and ethical integrity of research or novel treatment applications. This approach risks violating institutional policies and potentially national regulations governing the use of unapproved therapies. Administering the therapy based solely on the patient’s family’s strong desire, without a thorough review of the scientific evidence or institutional approval, is ethically unsound and potentially dangerous. It prioritizes patient or family preference over evidence-based medicine and established safety protocols, potentially exposing the patient to unproven risks without adequate justification. This neglects the physician’s duty to provide care that is both effective and safe. Initiating the treatment based on anecdotal evidence from a colleague, without formal institutional review or informed consent, is a serious breach of professional conduct. Anecdotal evidence is not a substitute for rigorous scientific validation or ethical review. This approach disregards the need for systematic evaluation of efficacy and safety and fails to adequately inform the patient about the experimental nature of the intervention, thus undermining informed consent. Professional Reasoning: Professionals should employ a structured decision-making process that begins with a thorough assessment of the clinical situation and the available evidence. This should be followed by an evaluation of ethical considerations, including patient autonomy, beneficence, and non-maleficence. Crucially, any deviation from standard practice, especially involving experimental treatments, must involve consultation with relevant institutional bodies such as ethics committees and IRBs. Transparency and comprehensive informed consent with the patient and their family are non-negotiable steps. This systematic approach ensures that decisions are both clinically sound and ethically defensible, protecting both the patient and the practitioner.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate needs of individual patients with the broader public health mandate of a neurohospitalist practice. The tension lies in allocating limited resources and clinical attention between acute care for individuals and proactive measures to address systemic health disparities within the community. Careful judgment is required to ensure that the practice upholds its ethical obligations to both individual patients and the population it serves, particularly when dealing with vulnerable groups. Correct Approach Analysis: The best professional approach involves actively engaging with local public health agencies and community organizations to understand the specific epidemiological patterns and health equity challenges affecting the neurohospitalist patient population. This includes collaborating on data collection, needs assessments, and the development of targeted interventions. This approach is correct because it aligns with the principles of population health management, which emphasizes understanding and improving the health of defined groups. It also directly addresses health equity by seeking to identify and mitigate barriers to care and health outcomes for underserved populations, as mandated by ethical guidelines for healthcare providers to promote social justice and reduce health disparities. Incorrect Approaches Analysis: An approach that focuses solely on treating individual patients presenting with neurological conditions, without considering the underlying social determinants of health or community-wide epidemiological trends, fails to address the root causes of health disparities. This approach neglects the population health mandate and the ethical imperative to promote equity. An approach that prioritizes research into rare neurological diseases without a clear link to the prevalent conditions or health needs of the local neurohospitalist patient population may divert resources from more pressing community health concerns. While research is valuable, it must be balanced with the immediate and demonstrable needs of the served population, particularly concerning equity. An approach that relies on anecdotal evidence from individual patient encounters to inform population health strategies, without systematic data collection or engagement with public health experts, is insufficient. This can lead to biased understanding and ineffective interventions, failing to accurately represent the epidemiological landscape or address systemic inequities. Professional Reasoning: Professionals should adopt a systematic decision-making process that begins with understanding the practice’s role within the broader community health ecosystem. This involves: 1) assessing the health needs of the patient population through epidemiological data and community engagement; 2) identifying specific health equity challenges and their determinants; 3) collaborating with relevant stakeholders, including public health bodies and community groups, to develop evidence-based, equitable interventions; and 4) continuously evaluating the impact of these interventions on both individual patient outcomes and population health metrics. This iterative process ensures that clinical practice is informed by and contributes to the health and well-being of the entire community.

Scenario Analysis: This scenario is professionally challenging because it involves a patient with a complex neurological condition who may have impaired capacity to fully grasp the implications of treatment options. Balancing the patient’s autonomy with the need for effective care, especially when a caregiver is involved, requires careful navigation of ethical principles and regulatory expectations regarding informed consent and shared decision-making. The neurohospitalist must assess the patient’s capacity, involve the caregiver appropriately, and ensure the decision-making process respects the patient’s values and preferences, even if they are difficult to articulate. Correct Approach Analysis: The best professional practice involves a structured approach to shared decision-making. This begins with a thorough assessment of the patient’s capacity to understand their condition and treatment options. If capacity is compromised, the neurohospitalist must engage the designated caregiver or next of kin in a way that respects the patient’s previously expressed wishes or best interests, while still prioritizing the patient’s involvement to the greatest extent possible. This approach aligns with the ethical imperative to respect patient autonomy and the regulatory requirement for informed consent, which necessitates that patients (or their legal representatives) understand the risks, benefits, and alternatives of proposed medical interventions. The process should be collaborative, ensuring the patient and caregiver feel heard and respected, and that the final decision reflects a shared understanding and agreement. Incorrect Approaches Analysis: One incorrect approach involves proceeding with a treatment plan solely based on the caregiver’s wishes without a thorough assessment of the patient’s capacity or their own expressed preferences. This fails to uphold the principle of patient autonomy and may violate regulations requiring direct patient consent or involvement in decision-making, even when capacity is limited. Another unacceptable approach is to present the patient with a single, predetermined treatment option without exploring alternatives or actively seeking their input, even if they have some capacity. This bypasses the core tenets of shared decision-making, which mandates a discussion of all reasonable options and a collaborative choice. It also neglects the ethical duty to provide comprehensive information to enable informed consent. A further professionally unsound approach is to exclude the caregiver entirely from discussions, even when the patient’s capacity is questionable and the caregiver is actively involved in their care. This can lead to decisions that are not in the patient’s best interest and can create mistrust between the medical team, the patient, and their support system, potentially hindering adherence to treatment. Professional Reasoning: Professionals should employ a framework that prioritizes patient-centered care. This involves: 1) assessing patient capacity; 2) if capacity is impaired, identifying and involving the appropriate surrogate decision-maker; 3) clearly and comprehensively explaining the medical condition, prognosis, and all viable treatment options, including risks, benefits, and alternatives; 4) actively listening to and understanding the patient’s and caregiver’s values, preferences, and concerns; 5) facilitating a collaborative discussion to reach a mutually agreeable decision; and 6) documenting the entire process, including capacity assessment and the shared decision reached.