Scenario Analysis: This scenario presents a common challenge in hematology and cellular therapy: differentiating between a potentially benign, self-limiting condition and a more serious underlying pathology that requires immediate, hypothesis-driven investigation. The patient’s vague symptoms and the physician’s initial broad differential diagnosis necessitate a structured and efficient approach to history taking and physical examination to avoid missing critical clues or ordering unnecessary, costly, and time-consuming investigations. The professional challenge lies in balancing thoroughness with efficiency, ensuring that the most likely diagnoses are explored first while remaining open to less common but serious possibilities. Correct Approach Analysis: The best approach involves a hypothesis-driven history and targeted physical examination. This means forming initial working hypotheses based on the patient’s chief complaint and then tailoring subsequent questions and examination maneuvers to confirm or refute these hypotheses. For example, if the initial complaint suggests a potential infection, the physician would focus on fever, chills, localized pain, and signs of inflammation, while also inquiring about recent exposures or travel. If the symptoms lean towards a hematological malignancy, the focus would shift to B symptoms (fever, night sweats, weight loss), lymphadenopathy, bruising, or bleeding. This method is ethically sound as it prioritizes patient well-being by efficiently directing diagnostic efforts towards the most probable causes, minimizing patient discomfort and resource utilization. It aligns with principles of good medical practice, emphasizing a systematic and evidence-based approach to diagnosis. Incorrect Approaches Analysis: One incorrect approach is to conduct a completely unfocused, exhaustive history and physical examination without any guiding hypotheses. This is inefficient, time-consuming, and can lead to information overload, potentially obscuring crucial findings. It fails to leverage clinical reasoning and can result in unnecessary investigations, increasing patient anxiety and healthcare costs, which is ethically questionable due to resource mismanagement. Another incorrect approach is to prematurely focus on a single, less likely diagnosis without adequately exploring more common or serious possibilities. This can lead to diagnostic bias and delays in identifying the true cause of the patient’s symptoms. For instance, if a patient presents with fatigue and pallor, immediately focusing on a rare autoimmune disorder without first considering common causes like iron deficiency anemia or vitamin B12 deficiency would be a significant diagnostic error. This approach risks missing the correct diagnosis and delaying appropriate treatment, which is a failure in professional duty of care. A further incorrect approach is to rely solely on a checklist of common hematological conditions without adapting the questioning and examination to the specific nuances of the patient’s presentation. While checklists can be useful, a truly hypothesis-driven approach requires dynamic adjustment of the diagnostic strategy based on emerging information from the patient’s history and initial physical findings. This rigid adherence to a predetermined list can lead to overlooking atypical presentations or less common but critical diagnoses. Professional Reasoning: Professionals should approach such cases by first identifying the chief complaint and any immediate red flags. Based on this initial information, they should formulate a short list of differential diagnoses, prioritizing those that are common, serious, or easily treatable. The history taking should then be structured to gather information that either supports or refutes these hypotheses. The physical examination should be similarly targeted, focusing on signs relevant to the working diagnoses. Throughout this process, it is crucial to remain open to new information and to revise the differential diagnosis as more data becomes available. This iterative process of hypothesis generation, testing, and refinement is the cornerstone of effective clinical decision-making in complex medical scenarios.

Scenario Analysis: This scenario is professionally challenging because it requires a nuanced understanding of the eligibility criteria for a specialized board certification. Misinterpreting these criteria can lead to wasted time, resources, and potential professional setbacks for aspiring candidates. It necessitates careful judgment to distinguish between general medical experience and the specific requirements for advanced hematology and cellular therapy practice as defined by the Nordic certification body. Correct Approach Analysis: The best approach involves a thorough review of the official guidelines published by the Comprehensive Nordic Medical Hematology and Cellular Therapy Board. These guidelines explicitly detail the educational pathways, clinical experience requirements, and any specific research or publication mandates necessary for eligibility. Adhering strictly to these documented requirements ensures that an applicant’s qualifications are assessed against the established standards, promoting fairness and upholding the integrity of the certification process. This aligns with the ethical principle of transparency and adherence to established professional standards. Incorrect Approaches Analysis: One incorrect approach is to assume that broad experience in general internal medicine or even general hematology is automatically sufficient. This fails to recognize that specialized board certifications have distinct and often more rigorous criteria tailored to the specific subspecialty. It overlooks the explicit requirement for focused training and experience in advanced hematology and cellular therapy. Another incorrect approach is to rely solely on informal advice from colleagues or mentors without verifying the information against the official certification body’s documentation. While well-intentioned, informal advice can be outdated, incomplete, or misinterpreted, leading to a misunderstanding of the precise eligibility requirements. This approach risks bypassing crucial, officially mandated qualifications. A further incorrect approach is to interpret the certification’s purpose as merely a general recognition of expertise in blood disorders. This misconstrues the specialized nature of the “Comprehensive Nordic Medical Hematology and Cellular Therapy” designation, which implies a higher level of proficiency and specific training in cutting-edge cellular therapies, not just general hematological knowledge. Professional Reasoning: Professionals seeking specialized board certification should always begin by consulting the official documentation from the certifying body. This documentation serves as the definitive guide to eligibility. When faced with ambiguity, direct communication with the certification board is the most reliable method for clarification. A systematic approach, starting with official guidelines and seeking direct confirmation when needed, ensures that all requirements are met accurately and efficiently, thereby upholding professional integrity and maximizing the chances of successful certification.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexity of managing patient data in a multi-disciplinary, research-oriented setting. Balancing the need for timely access to critical patient information for ongoing clinical care and research with the stringent requirements of data privacy and consent management under Nordic data protection regulations (specifically GDPR as implemented in Nordic countries) requires careful judgment. Missteps can lead to severe regulatory penalties, erosion of patient trust, and compromised research integrity. Correct Approach Analysis: The best professional practice involves a systematic approach to data access and utilization that prioritizes explicit, informed consent and robust anonymization techniques. This means ensuring that any patient data used for research purposes, even within the same institution, has been obtained with the patient’s clear and specific consent for that particular research project or a clearly defined category of research. Where direct patient identifiers are not essential for the research question, anonymization or pseudonymization should be employed to protect patient privacy. This approach aligns directly with the principles of data minimization and purpose limitation enshrined in GDPR, ensuring that data is processed only for the specified, legitimate purposes for which consent was given. It upholds the fundamental right to privacy and control over personal data. Incorrect Approaches Analysis: Utilizing patient data for a new research project without re-confirming consent, even if the data was initially collected for a related clinical purpose, constitutes a failure to adhere to the principle of purpose limitation and the requirement for explicit consent for new processing activities. This bypasses the patient’s right to control how their data is used beyond their direct clinical care. Sharing raw, identifiable patient data with external research collaborators without a clear legal basis, such as a data processing agreement that explicitly outlines consent status and security measures, violates data protection regulations. This exposes patient data to unauthorized access and potential misuse, and breaches the trust placed in the institution. Assuming that consent for clinical treatment automatically extends to all future research endeavors, regardless of the nature or scope of that research, is a significant ethical and regulatory misstep. GDPR requires that consent be freely given, specific, informed, and unambiguous, and this assumption undermines these core tenets. Professional Reasoning: Professionals in this field must adopt a proactive and ethically grounded approach to data management. This involves: 1. Thoroughly understanding the specific consent obtained from each patient for both clinical care and any research activities. 2. Implementing robust data governance policies that clearly define data access protocols, anonymization standards, and data sharing procedures. 3. Regularly reviewing and updating consent forms and data usage agreements to ensure they meet current regulatory requirements and ethical best practices. 4. Seeking legal and ethical review for any research project involving patient data to ensure full compliance. 5. Prioritizing patient privacy and autonomy in all data-related decisions, recognizing that trust is paramount.

Scenario Analysis: This scenario is professionally challenging due to the inherent complexity of diagnosing rare hematological disorders. Clinicians must balance the need for timely and accurate diagnosis with the potential for patient harm from unnecessary or inappropriate investigations. The selection and interpretation of imaging studies require a nuanced understanding of both the disease process and the capabilities and limitations of various imaging modalities, all within the framework of patient safety and resource optimization. Correct Approach Analysis: The best professional practice involves a systematic, evidence-based approach that begins with a thorough clinical assessment and consideration of the most probable diagnoses based on patient presentation and initial laboratory findings. This leads to the judicious selection of imaging modalities that are most likely to yield diagnostically relevant information for the suspected conditions, prioritizing non-invasive or minimally invasive techniques where appropriate. Interpretation then involves integrating imaging findings with clinical and laboratory data, often requiring consultation with radiologists and hematologists to ensure accurate diagnosis and guide subsequent management. This approach aligns with ethical principles of beneficence and non-maleficence, ensuring that investigations are performed for a clear clinical purpose and minimize patient risk. It also reflects professional guidelines that emphasize a stepwise diagnostic process to avoid unnecessary costs and patient burden. Incorrect Approaches Analysis: One incorrect approach involves ordering a broad range of advanced imaging studies without a clear diagnostic hypothesis. This is professionally unacceptable as it can lead to significant patient exposure to radiation or contrast agents, unnecessary financial costs, and the generation of incidental findings that may cause patient anxiety and further investigations. It fails to adhere to the principle of proportionality in medical investigations. Another incorrect approach is to rely solely on imaging findings without integrating them with the patient’s clinical history and laboratory results. This can lead to misinterpretation of imaging, where findings are attributed to a hematological condition when they are actually unrelated or secondary to other processes. This approach violates the principle of holistic patient care and can result in diagnostic errors. A further incorrect approach is to delay necessary imaging investigations due to an over-reliance on less sensitive diagnostic methods or a reluctance to involve specialized imaging expertise. This can lead to delayed diagnosis and treatment, potentially worsening patient outcomes and violating the duty of care to provide timely medical intervention. Professional Reasoning: Professionals should employ a diagnostic reasoning framework that prioritizes a comprehensive clinical assessment, followed by the formulation of differential diagnoses. Imaging selection should be guided by the likelihood of each differential diagnosis and the specific information required to confirm or exclude it. Interpretation must always be a collaborative process, integrating all available data. This systematic approach ensures that investigations are targeted, efficient, and patient-centered, maximizing diagnostic yield while minimizing risk and resource utilization.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate needs of a patient with acute symptoms against the long-term implications of chronic conditions and the proactive measures needed for prevention. The physician must navigate potential diagnostic uncertainty, resource limitations, and the ethical imperative to provide comprehensive, evidence-based care that addresses all facets of the patient’s hematological health. Careful judgment is required to prioritize interventions, communicate effectively with the patient, and ensure adherence to established clinical guidelines and ethical principles. Correct Approach Analysis: The best professional practice involves a comprehensive, integrated approach that simultaneously addresses the acute presentation while also evaluating for and managing underlying chronic conditions and implementing preventive strategies. This approach begins with a thorough diagnostic workup to identify the cause of the acute symptoms, which may include laboratory tests, imaging, and potentially bone marrow examination. Concurrently, the physician should assess the patient’s history for any pre-existing hematological disorders or risk factors for chronic conditions. Based on the findings, a personalized management plan is developed that includes immediate treatment for the acute issue, long-term management of any identified chronic conditions (e.g., regular monitoring, specific therapies), and proactive measures to prevent future complications or the development of new hematological problems (e.g., lifestyle modifications, prophylactic treatments if indicated). This holistic strategy aligns with the principles of evidence-based medicine by utilizing the latest research and guidelines to optimize patient outcomes across the spectrum of care. Ethically, it upholds the principle of beneficence by acting in the patient’s best interest and non-maleficence by minimizing harm through comprehensive assessment and management. Incorrect Approaches Analysis: Focusing solely on the acute symptoms without investigating potential underlying chronic conditions is professionally unacceptable. This approach fails to address the root cause of the patient’s presentation, potentially leading to recurrent acute episodes, progression of an undiagnosed chronic disease, and suboptimal long-term health outcomes. It neglects the evidence-based mandate to consider the full clinical picture. Prioritizing the management of a suspected chronic condition over the immediate, acute symptoms is also professionally unsound. While chronic conditions require attention, acute, symptomatic presentations often demand urgent intervention to prevent immediate harm or deterioration. Ignoring acute distress in favor of a less pressing chronic concern violates the ethical duty to alleviate suffering and can lead to severe consequences. Adopting a purely symptomatic treatment approach without seeking a definitive diagnosis or considering long-term management and prevention is a significant ethical and professional failing. This reactive strategy does not align with evidence-based practice, which emphasizes understanding the etiology of disease. It risks masking serious underlying pathology, delaying appropriate treatment, and failing to equip the patient with the knowledge and tools for long-term health maintenance, thereby potentially causing harm and failing to meet the standard of care. Professional Reasoning: Professionals should employ a systematic decision-making process that begins with a thorough patient assessment, encompassing history, physical examination, and initial diagnostic investigations. This should be followed by a differential diagnosis that considers acute, chronic, and preventive aspects of hematological health. Evidence-based guidelines and current literature should then inform the selection of diagnostic tests and therapeutic interventions. Crucially, communication with the patient is paramount, ensuring they understand their condition, the rationale for proposed treatments, and the importance of follow-up and preventive measures. A continuous evaluation of the patient’s response to treatment and adjustment of the management plan as needed is also essential.

The scenario presents a common challenge for medical professionals seeking advanced certification: understanding and navigating the specific policies governing examination attempts and scoring. This is professionally challenging because adherence to these policies directly impacts career progression and the ability to practice within a specialized field. Misunderstanding or misapplying these rules can lead to significant personal and professional setbacks. Careful judgment is required to ensure all candidates are treated equitably and that the certification process maintains its integrity. The best approach involves a thorough and proactive understanding of the Nordic Medical Hematology and Cellular Therapy Board Certification’s official blueprint, which explicitly details blueprint weighting, scoring methodologies, and retake policies. This includes understanding how different sections of the exam contribute to the overall score, the minimum passing score, and the conditions under which a candidate may retake the examination, including any time limits or required remediation. This approach is correct because it aligns with the principles of transparency and fairness inherent in any professional certification process. By consulting the official documentation, candidates ensure they are operating under the established rules, thereby avoiding potential disputes or disqualifications. This proactive engagement with the certification body’s guidelines is ethically sound and professionally responsible. An incorrect approach would be to rely on informal discussions or anecdotal evidence from colleagues regarding the exam’s scoring or retake policies. This is professionally unacceptable because it introduces a high risk of misinformation. Official policies are the definitive source, and deviations from them, even if based on seemingly reliable hearsay, can lead to incorrect assumptions about passing thresholds or retake eligibility, potentially causing candidates to miss crucial deadlines or misunderstandings about their performance. Another incorrect approach is to assume that the scoring and retake policies are universally applied across all medical board certifications. While there may be common principles, each certifying body, including the Nordic Medical Hematology and Cellular Therapy Board, establishes its own unique framework. This assumption is professionally flawed as it ignores the specific regulatory environment of the certification in question, leading to potential misinterpretations of the actual requirements and procedures. A further incorrect approach is to focus solely on the content of the examination without understanding the procedural aspects of scoring and retakes. While mastery of the subject matter is paramount, ignorance of the examination’s administrative policies can be just as detrimental. For instance, a candidate might perform exceptionally well on the content but be unaware of a strict limit on the number of retakes, leading to an unexpected disqualification after a second attempt. The professional decision-making process for similar situations should involve a commitment to seeking out and understanding official documentation. This includes meticulously reviewing the certification body’s website, candidate handbooks, and any published guidelines related to examination structure, scoring, and retake policies. When in doubt, direct communication with the certification board’s administrative staff is the most reliable method to clarify any ambiguities. This ensures that decisions regarding preparation, examination strategy, and subsequent actions are based on accurate and authoritative information, upholding professional integrity and maximizing the chances of successful certification.

The risk matrix shows a candidate preparing for the Comprehensive Nordic Medical Hematology and Cellular Therapy Board Certification facing a common challenge: balancing comprehensive study with limited time and the vastness of the curriculum. This scenario is professionally challenging because inadequate preparation can lead to patient care errors, ethical breaches in practice, and professional reputational damage. Careful judgment is required to select the most effective and efficient preparation strategy. The best approach involves a structured, multi-modal study plan that prioritizes high-yield topics identified through practice questions and recent exam trends, while also incorporating foundational knowledge review. This method is correct because it aligns with best practices in adult learning and professional development, emphasizing active recall and spaced repetition. It also implicitly addresses the ethical imperative to maintain competence, ensuring that the candidate acquires the necessary knowledge to provide safe and effective patient care, as expected by professional medical bodies and regulatory authorities in the Nordic region concerning medical expertise. This proactive and evidence-based preparation minimizes the risk of knowledge gaps that could impact clinical decision-making. An approach that relies solely on passively reviewing textbooks without active engagement or practice questions is professionally unacceptable. This fails to adequately test comprehension and retention, potentially leading to a false sense of preparedness. It neglects the ethical obligation to thoroughly assess one’s own knowledge base before undertaking critical medical responsibilities. Another professionally unacceptable approach is to focus exclusively on obscure or niche topics, neglecting the core competencies and frequently tested areas of hematology and cellular therapy. This strategy is inefficient and ethically questionable, as it prioritizes less critical information over the foundational knowledge essential for competent practice and patient safety. It demonstrates a misunderstanding of the purpose of board certification, which is to establish a baseline of essential knowledge and skills. Finally, adopting a last-minute cramming strategy without a structured timeline is also professionally unsound. This method is known to be ineffective for long-term knowledge retention and increases the likelihood of superficial understanding. It fails to meet the ethical standard of diligent preparation required for a medical board certification, potentially jeopardizing patient well-being due to incomplete or poorly retained knowledge. Professionals should employ a decision-making framework that involves self-assessment of current knowledge, identification of learning objectives based on exam blueprints and practice analyses, and the creation of a realistic, phased study schedule. This framework should incorporate diverse learning methods and regular self-testing to ensure comprehensive and robust preparation.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexity of integrating foundational biomedical sciences with clinical medicine in the context of advanced cellular therapies. The rapid evolution of this field, coupled with the critical need for patient safety and ethical practice, demands a rigorous and evidence-based approach to treatment decisions. Professionals must navigate the nuances of scientific discovery, clinical application, and regulatory compliance, ensuring that patient care is both innovative and safe. Correct Approach Analysis: The best professional practice involves a comprehensive review of the latest peer-reviewed scientific literature and established clinical guidelines, specifically focusing on the preclinical and early clinical data for the novel CAR-T therapy. This approach is correct because it prioritizes evidence-based medicine, which is a cornerstone of ethical and safe patient care. Regulatory frameworks, such as those overseen by the European Medicines Agency (EMA) and national competent authorities, mandate that novel treatments are introduced only after thorough scientific validation and risk-benefit assessment. Adhering to established guidelines ensures that the proposed treatment aligns with current best practices and has undergone appropriate scrutiny for efficacy and safety. This systematic evaluation minimizes the risk of introducing unproven or potentially harmful therapies. Incorrect Approaches Analysis: One incorrect approach involves relying solely on anecdotal evidence from a single, albeit reputable, research institution. While anecdotal reports can sometimes highlight promising avenues, they do not constitute robust scientific evidence and lack the rigor of controlled studies. This approach fails to meet the standards for evidence-based medicine and could lead to the adoption of treatments that have not been adequately validated for safety or efficacy, potentially violating ethical principles of non-maleficence and patient autonomy. Another incorrect approach is to proceed with the therapy based on the patient’s expressed strong desire and the perceived urgency of their condition, without a thorough independent scientific and clinical review. While patient wishes are paramount, they must be balanced against the physician’s ethical and professional responsibility to provide care that is supported by evidence and adheres to regulatory standards. This approach risks prioritizing patient demand over established safety protocols and scientific validation, potentially leading to harm. A further incorrect approach is to defer the decision entirely to the treating physician’s personal experience with similar, but not identical, therapies. While clinical experience is valuable, it is not a substitute for a systematic evaluation of the specific novel therapy in question. Each cellular therapy has unique characteristics, potential toxicities, and efficacy profiles. Relying solely on past experience with different therapies can lead to misjudgment of risks and benefits, failing to account for the specific scientific underpinnings and clinical data of the new treatment. Professional Reasoning: Professionals should adopt a decision-making framework that begins with a thorough and critical appraisal of all available scientific evidence, including preclinical data, phase I/II/III clinical trial results, and relevant meta-analyses. This evidence should then be weighed against established clinical guidelines and regulatory requirements. Patient preferences and values should be integrated into the decision-making process, but only after a comprehensive understanding of the scientific and clinical evidence has been established. Open communication with the patient, including a detailed discussion of the known risks, benefits, and uncertainties, is essential. In cases of novel therapies, consultation with multidisciplinary teams and ethics committees may also be warranted to ensure the highest standards of patient care and ethical conduct.

Scenario Analysis: This scenario presents a professional challenge rooted in the inherent tension between patient autonomy, the physician’s duty of care, and the evolving landscape of medical knowledge and treatment options. The physician must navigate a situation where a patient’s deeply held beliefs conflict with a potentially life-saving intervention, requiring a delicate balance of respect, information, and ethical responsibility. Careful judgment is required to ensure the patient’s rights are upheld while also fulfilling the physician’s obligation to provide appropriate medical care and guidance. Correct Approach Analysis: The best professional practice involves a comprehensive and empathetic discussion with the patient, exploring the rationale behind their refusal and ensuring they fully understand the implications of their decision. This approach prioritizes informed consent and respects patient autonomy. It requires the physician to actively listen, address the patient’s concerns, and provide clear, unbiased information about the risks and benefits of the proposed treatment, as well as the potential consequences of refusal. The physician should also explore any underlying fears or misunderstandings that may be influencing the patient’s decision and offer alternative, less invasive options if medically appropriate and consistent with the patient’s values. This aligns with the fundamental ethical principles of respect for autonomy and beneficence, ensuring the patient’s decision is truly informed and voluntary. Incorrect Approaches Analysis: One incorrect approach involves overriding the patient’s wishes based solely on the physician’s professional judgment that the treatment is medically superior. This fails to respect patient autonomy and the right to make decisions about one’s own body, even if those decisions seem medically suboptimal. It can lead to a breakdown of trust and potentially result in the patient disengaging from care altogether. Another incorrect approach is to simply document the patient’s refusal without further exploration or ensuring comprehension. This approach neglects the physician’s duty to inform and counsel the patient, potentially leaving the patient with incomplete understanding of their condition and treatment options. It also fails to identify and address any potential coercion or lack of capacity that might be influencing the patient’s decision. A third incorrect approach is to pressure the patient by emphasizing only the dire consequences of refusal without acknowledging their concerns or exploring their values. This can be perceived as coercive and undermines the principle of shared decision-making. It does not foster a collaborative relationship and may lead to resentment or a feeling of being unheard. Professional Reasoning: Professionals should employ a decision-making framework that begins with active listening and empathetic engagement to understand the patient’s perspective. This should be followed by a thorough assessment of the patient’s capacity to make decisions and the presence of any undue influence. The physician must then provide comprehensive, balanced information about all available options, including the risks, benefits, and alternatives, ensuring the patient understands this information. The process should culminate in a shared decision that respects the patient’s values and autonomy, with clear documentation of the discussion and the patient’s final decision.

This scenario presents a significant professional challenge due to the inherent conflict between a physician’s duty to provide optimal care and the patient’s right to self-determination, particularly when the patient’s decision-making capacity is in question. The physician must navigate complex ethical principles and legal requirements surrounding informed consent and patient autonomy while ensuring the patient’s well-being. The best approach involves a systematic assessment of the patient’s capacity to make decisions regarding their treatment. This includes engaging in a thorough discussion with the patient about their diagnosis, prognosis, treatment options (including risks, benefits, and alternatives), and the implications of refusing treatment. If capacity is confirmed, the physician must respect the patient’s informed decision, even if it differs from the physician’s recommendation. If capacity is uncertain or impaired, the physician must follow established protocols for assessing and supporting decision-making, which may involve involving family members or legal guardians, and potentially seeking a formal capacity assessment. This aligns with the fundamental ethical principles of autonomy and beneficence, as well as legal frameworks that protect patient rights and ensure valid consent. An incorrect approach would be to proceed with treatment without a clear understanding of the patient’s capacity or to override a patient’s decision without due process. For instance, assuming a patient lacks capacity solely based on their diagnosis or a perceived lack of understanding, without a formal assessment, violates the principle of autonomy and can lead to inappropriate medical interventions. Similarly, disregarding a patient’s expressed wishes, even if they seem contrary to their best interests, without exploring the underlying reasons or assessing capacity, is ethically unsound and legally problematic. Another flawed approach would be to coerce or unduly influence the patient into accepting a particular treatment, which undermines the voluntariness aspect of informed consent and constitutes a breach of professional ethics. Professionals should employ a decision-making process that prioritizes patient autonomy and capacity assessment. This involves: 1) establishing a trusting relationship with the patient; 2) clearly communicating medical information in an understandable manner; 3) actively assessing the patient’s understanding and ability to make a choice; 4) respecting the patient’s decision if they have capacity; and 5) implementing appropriate steps to support decision-making or involve surrogate decision-makers if capacity is impaired.