Scenario Analysis: This scenario presents a common challenge in geriatric care where a patient with multiple comorbidities and polypharmacy experiences an acute exacerbation of a chronic condition. The professional challenge lies in balancing the immediate need for symptom relief with the long-term implications of treatment on the patient’s overall health, functional status, and quality of life, especially considering potential drug interactions and the risk of iatrogenic harm. Careful judgment is required to avoid over-treatment or under-treatment, and to ensure that interventions align with the patient’s goals of care. Correct Approach Analysis: The best professional practice involves a comprehensive, individualized assessment that prioritizes the patient’s stated preferences and values, alongside a thorough review of their current medications and existing comorbidities. This approach recognizes that evidence-based management in geriatrics is not a one-size-fits-all model but requires tailoring interventions to the unique circumstances of each older adult. It emphasizes shared decision-making, where the clinician and patient (and their caregivers, if appropriate) collaboratively determine the most suitable course of action, considering the potential benefits and harms of each treatment option in the context of the patient’s overall health trajectory and life goals. This aligns with ethical principles of autonomy and beneficence, and regulatory frameworks that promote patient-centered care. Incorrect Approaches Analysis: One incorrect approach involves solely focusing on aggressive symptom management using standard protocols for younger adults, without adequately considering the patient’s age, frailty, polypharmacy, and potential for adverse drug events. This fails to adhere to the principle of individualized care and can lead to iatrogenic harm, contravening the ethical duty to do no harm. Another incorrect approach is to dismiss the acute symptoms as an inevitable consequence of aging and opt for minimal intervention, thereby neglecting the potential for reversible causes and failing to uphold the duty of beneficence. A third incorrect approach is to implement a new medication regimen based on guidelines for a specific condition without a comprehensive review of the patient’s existing medication list, increasing the risk of dangerous drug interactions and polypharmacy, which is a significant concern in geriatric care and often addressed by professional guidelines aimed at medication safety. Professional Reasoning: Professionals should employ a systematic approach that begins with a thorough patient assessment, including a review of their medical history, current medications, functional status, cognitive function, and personal preferences. This should be followed by an evidence-based evaluation of treatment options, considering the specific condition, the patient’s comorbidities, and potential interactions. Shared decision-making with the patient and their family is paramount. Professionals must also be vigilant for signs of polypharmacy and potential adverse drug reactions, and be prepared to de-escalate or adjust treatments as needed, always prioritizing the patient’s overall well-being and quality of life.

Scenario Analysis: This scenario presents a challenge in navigating the evolving landscape of specialized medical board certifications, particularly in a global context. Professionals must understand the precise criteria for eligibility and the underlying purpose of such certifications to ensure their efforts are aligned with recognized standards and contribute meaningfully to the field. Misinterpreting the purpose or eligibility can lead to wasted resources, misrepresentation of qualifications, and a failure to meet the intended objectives of the certification. Correct Approach Analysis: The best approach involves a thorough examination of the official documentation outlining the purpose and eligibility requirements for the Critical Global Geriatric Medicine Board Certification. This includes understanding that the certification aims to recognize physicians with advanced expertise in geriatric medicine, specifically addressing the unique health challenges of aging populations in diverse global settings. Eligibility criteria are designed to ensure candidates possess the necessary clinical experience, specialized training, and a commitment to advancing geriatric care on an international scale. Adhering strictly to these established guidelines ensures that the certification process is fair, transparent, and upholds the integrity of the specialization. Incorrect Approaches Analysis: One incorrect approach would be to assume that general geriatric medicine board certification automatically confers eligibility for a specialized global certification. This fails to acknowledge that global geriatric medicine may have distinct requirements related to cross-cultural competence, understanding of global health disparities, and experience with international healthcare systems, which are not necessarily covered by a standard national certification. Another incorrect approach would be to rely on anecdotal evidence or informal discussions with colleagues regarding eligibility. While peer insights can be valuable, they are not a substitute for official guidelines. This can lead to misinterpretations of nuanced requirements or the inclusion of criteria that are not officially recognized, potentially disqualifying a candidate or leading to an inaccurate self-assessment. A further incorrect approach would be to focus solely on the desire for advanced recognition without a clear understanding of the specific competencies the Critical Global Geriatric Medicine Board Certification seeks to validate. This could lead to an applicant pursuing certification without possessing the core skills and knowledge deemed essential for addressing critical global geriatric health issues, undermining the purpose of the certification itself. Professional Reasoning: Professionals should approach specialized board certifications by prioritizing official sources of information. This involves actively seeking out and meticulously reviewing the governing body’s published purpose statements, eligibility criteria, and application guidelines. A systematic comparison of one’s own qualifications against these documented requirements is essential. When in doubt, direct communication with the certifying body is the most reliable method to clarify any ambiguities. This ensures that professional development and certification pursuits are grounded in accurate information and aligned with the established standards of the specialty.

The assessment process reveals a common yet complex challenge in geriatric medicine: differentiating between age-related physiological changes and early signs of pathology, particularly when imaging findings are subtle or equivocal. This scenario is professionally challenging because older adults often present with multiple comorbidities, polypharmacy, and atypical symptom presentations, making it difficult to isolate the cause of new neurological deficits. The risk of over-diagnosis and unnecessary invasive procedures is balanced against the imperative to identify treatable conditions early. Careful judgment is required to avoid diagnostic inertia while also preventing iatrogenic harm. The best approach involves a systematic, multi-modal diagnostic reasoning workflow that prioritizes clinical correlation and judicious use of imaging. This begins with a thorough history and physical examination, focusing on the onset, progression, and specific nature of the neurological symptoms, alongside a comprehensive review of the patient’s medical history, medications, and functional status. Based on this clinical assessment, the clinician then selects the most appropriate initial imaging modality. For suspected acute neurological events like stroke, a non-contrast head CT is typically the first-line investigation due to its speed and availability, followed by MRI if further detail is needed or if the CT is inconclusive. For more chronic or subtle neurological changes, an MRI of the brain is often the preferred initial advanced imaging modality, providing superior soft tissue contrast to detect lesions indicative of demyelination, tumors, or chronic ischemic changes. Interpretation of imaging must always be performed in the context of the patient’s clinical presentation, considering potential confounding factors such as age-related white matter changes or incidental findings. This integrated approach ensures that imaging serves to confirm or refute clinical hypotheses rather than driving the diagnostic process in isolation. An incorrect approach would be to immediately order advanced neuroimaging, such as an MRI, without a thorough clinical evaluation and consideration of less resource-intensive initial investigations. This bypasses the crucial step of formulating a differential diagnosis based on clinical data, potentially leading to the ordering of inappropriate or unnecessary tests. Ethically, this can be seen as a failure to practice cost-effective medicine and a potential violation of the principle of non-maleficence if the advanced imaging carries risks or leads to further invasive investigations without clear clinical indication. Another incorrect approach is to dismiss subtle imaging findings as solely attributable to normal aging without adequate clinical correlation. While age-related changes in the brain are common, they can also mask or mimic pathological processes. Failing to investigate further when clinical symptoms suggest a new or worsening condition, simply because some imaging findings are consistent with age, can lead to missed diagnoses of treatable conditions like early-stage dementia, tumors, or inflammatory disorders. This represents a failure in diagnostic diligence and can result in significant harm to the patient due to delayed or absent treatment. Finally, relying solely on the interpretation of a radiologist’s report without integrating it with the patient’s clinical picture is a flawed strategy. Radiologists provide expert interpretation of images, but they do not have access to the full clinical context. A finding that may be considered incidental or age-related by a radiologist might be highly significant in the context of a patient’s specific symptoms and history. This disconnect can lead to misdiagnosis or delayed diagnosis, as the clinical significance of the imaging finding is not fully appreciated. The professional decision-making process for similar situations should involve a structured approach: 1) Comprehensive Clinical Assessment: Gather detailed history, perform a thorough physical and neurological examination, and review all relevant medical data. 2) Formulate a Differential Diagnosis: Based on the clinical assessment, generate a list of potential causes for the patient’s symptoms. 3) Select Appropriate Investigations: Choose diagnostic tests, including imaging, that are most likely to confirm or refute the leading diagnoses in the differential, considering the risks, benefits, and cost-effectiveness. 4) Integrate Findings: Critically evaluate the results of all investigations in conjunction with the clinical presentation. 5) Re-evaluate and Refine: If initial investigations are inconclusive, revise the differential diagnosis and consider further testing or specialist consultation.

The assessment process reveals a critical juncture for a geriatrician preparing for board certification. The scenario is professionally challenging because it requires a nuanced understanding of the examination’s structure and policies, which directly impacts career progression and the ability to practice. Misinterpreting blueprint weighting, scoring, or retake policies can lead to significant wasted effort, financial loss, and prolonged delays in achieving certification, potentially affecting patient care by delaying access to specialized geriatric expertise. Careful judgment is required to align study efforts with examination demands and to navigate the consequences of examination outcomes. The best professional approach involves a thorough and proactive review of the official examination blueprint and accompanying policies. This includes understanding how different content areas are weighted, the specific scoring methodology (e.g., pass/fail, scaled scores, item response theory), and the detailed retake policy, including any limitations on the number of attempts, waiting periods, or required remediation. This approach is correct because it is grounded in direct adherence to the certifying body’s stated requirements. Such diligence ensures that study resources are allocated efficiently to high-yield topics, that expectations for performance are realistic, and that a clear plan is in place for any potential retake scenarios, thereby minimizing uncertainty and maximizing the chances of success within the established framework. This aligns with ethical obligations to prepare competently and to engage with the certification process responsibly. An incorrect approach involves relying on anecdotal information or outdated study guides to infer blueprint weighting and scoring. This is professionally unacceptable because it deviates from the authoritative source of information, leading to misallocation of study time and potentially unrealistic performance expectations. The specific regulatory and ethical failure lies in a lack of due diligence and a disregard for the official guidelines set by the certifying body, which are designed to ensure standardized and fair assessment. Another incorrect approach is to disregard the retake policy, assuming a single attempt will suffice and not planning for contingencies. This is professionally unsound as it demonstrates a failure to anticipate potential challenges and to prepare for all aspects of the examination process. The ethical failure here is a lack of preparedness and a potentially cavalier attitude towards a significant professional milestone, which could lead to prolonged delays in certification and impact the ability to serve the geriatric population. A further incorrect approach is to focus solely on mastering a broad range of geriatric medicine topics without considering the specific weighting indicated in the blueprint. This leads to inefficient study habits, as disproportionate time may be spent on low-yield areas at the expense of high-yield topics. The professional and ethical failure is in not optimizing the study strategy based on the explicit guidance provided by the examination setters, thereby failing to demonstrate the most critical competencies as defined by the board. The professional decision-making process for similar situations should involve a systematic approach: always consult the primary source for examination requirements, allocate study time based on blueprint weighting, understand the scoring mechanism to set realistic performance goals, and thoroughly review all policies, including retake procedures, to ensure comprehensive preparedness and a clear understanding of the path to certification.

Scenario Analysis: This scenario is professionally challenging because it requires a candidate to balance the desire for comprehensive preparation with the realities of time constraints and the potential for information overload. The critical decision lies in selecting resources that are both authoritative and efficient, ensuring that preparation is targeted and effective without leading to burnout or superficial understanding. The pressure to perform well on a board certification exam, especially in a specialized field like Geriatric Medicine, necessitates a strategic approach to learning. Correct Approach Analysis: The best approach involves a structured, multi-modal strategy that prioritizes foundational knowledge and evidence-based guidelines, supplemented by practice questions and peer discussion. This method acknowledges that board certification requires not just memorization but also the ability to apply knowledge in clinical scenarios. Focusing on core geriatric syndromes, age-related physiological changes, and common geriatric conditions, using resources like established textbooks, consensus guidelines from reputable geriatric societies, and peer-reviewed journals, provides a robust knowledge base. Incorporating practice questions helps identify knowledge gaps and familiarizes the candidate with exam format and question style. Engaging in study groups or discussions with peers allows for clarification of complex topics and exposure to different perspectives, fostering deeper understanding. This integrated approach ensures comprehensive coverage, practical application, and efficient use of study time. Incorrect Approaches Analysis: Relying solely on a single, comprehensive textbook without supplementary materials risks missing the nuances of exam focus or failing to develop application skills. Textbooks, while valuable, may not always reflect the most current clinical practice or exam emphasis. Over-reliance on a vast array of online resources, without critical evaluation of their authority or relevance, can lead to information overload, confusion, and wasted time on outdated or less pertinent material. This approach lacks the structure and focus necessary for effective board preparation. Focusing exclusively on practice questions without a solid understanding of the underlying principles can lead to rote memorization of answers without true comprehension, making it difficult to adapt to novel clinical scenarios presented in the exam. This approach fails to build a foundational knowledge base. Attempting to cram a large volume of information in the final weeks before the exam is a recipe for burnout and superficial learning. This approach neglects the importance of spaced repetition and deep processing of information, leading to poor retention and recall under pressure. Professional Reasoning: Professionals preparing for board certification should adopt a strategic, evidence-based approach to resource selection and time management. This involves identifying authoritative sources, prioritizing core competencies, and integrating active learning techniques such as practice questions and peer discussion. A realistic timeline should be established, allowing for gradual assimilation of knowledge and regular review. Continuous self-assessment through practice questions is crucial for identifying areas needing further attention. The goal is to achieve a deep, applied understanding of the subject matter, not merely to memorize facts.

The analysis reveals a scenario that is professionally challenging due to the inherent conflict between a patient’s expressed wishes and the perceived best interests of their family, compounded by the complexities of geriatric care where cognitive status and decision-making capacity can fluctuate. Careful judgment is required to navigate these sensitive interpersonal dynamics while upholding ethical and professional standards. The best approach involves a structured, patient-centered communication strategy that prioritizes the patient’s autonomy and dignity. This entails engaging in open and empathetic dialogue with both the patient and their family, seeking to understand the underlying concerns of each party. Crucially, it requires a thorough assessment of the patient’s capacity to make decisions regarding their care, utilizing validated tools and involving a multidisciplinary team if necessary. If the patient is deemed to have capacity, their informed decisions must be respected, even if they differ from the family’s preferences. This aligns with fundamental ethical principles of autonomy and beneficence, as well as professional guidelines emphasizing patient-centered care and shared decision-making. An approach that solely prioritizes the family’s wishes, disregarding the patient’s expressed preferences, represents a significant ethical failure. It undermines patient autonomy and can lead to a breach of trust, potentially causing distress to the patient and damaging the therapeutic relationship. Similarly, an approach that unilaterally imposes a treatment plan without adequate discussion or consideration of the patient’s perspective, even if perceived as medically optimal, fails to uphold the principle of informed consent and patient-centered care. Finally, an approach that avoids direct communication with either the patient or the family, or delegates the difficult conversations entirely to another team member without clear direction, demonstrates a lack of professional responsibility and can exacerbate the situation. Professionals should employ a decision-making framework that begins with active listening and empathetic engagement. This should be followed by a comprehensive assessment of the patient’s clinical status and decision-making capacity. Open, honest, and culturally sensitive communication with all involved parties is paramount. When conflicts arise, the focus should remain on the patient’s best interests, defined by their own values and preferences, supported by evidence-based medical guidance. Escalation to ethics committees or senior colleagues should be considered when complex ethical dilemmas persist.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the patient’s immediate clinical needs with the ethical imperative of obtaining informed consent, especially when dealing with a vulnerable population like geriatric patients who may have fluctuating cognitive abilities. The physician must navigate potential communication barriers, ensure comprehension, and respect the patient’s autonomy while also considering the best interests of the patient and the potential for harm if treatment is delayed or inappropriate. Correct Approach Analysis: The best professional practice involves a multi-faceted approach to informed consent. This includes a thorough assessment of the patient’s capacity to understand their condition, the proposed treatment, alternatives, and risks. If capacity is present, the physician should engage in a clear, patient-centered discussion, using plain language and visual aids if necessary, to ensure the patient comprehends the information. The physician should actively solicit questions and confirm understanding before proceeding. This aligns with the fundamental ethical principles of autonomy and beneficence, and regulatory frameworks that mandate informed consent as a prerequisite for medical intervention, ensuring the patient is an active participant in their care. Incorrect Approaches Analysis: Proceeding with treatment based solely on the assumption that the patient’s long-standing relationship with the physician implies consent is ethically and regulatorily unsound. This approach disregards the requirement for explicit, informed consent for each significant medical decision and fails to account for potential changes in the patient’s understanding or wishes. It violates the principle of autonomy. Initiating a complex diagnostic procedure without a clear assessment of the patient’s capacity to consent, even with the family present, is problematic. While family involvement is often crucial, the ultimate decision-making authority rests with the patient if they have capacity. Relying solely on family consent without assessing the patient’s understanding and wishes, or without a formal capacity assessment if doubt exists, can lead to treatment that is not aligned with the patient’s values or preferences, potentially violating beneficence and autonomy. Delaying all necessary treatment until a formal, time-consuming capacity assessment is completed, even when the patient appears to understand and agree to the proposed course of action, can be detrimental. While capacity assessment is important, it should be a process integrated into the clinical encounter, not necessarily a standalone, protracted event that compromises timely care, especially in acute situations. This could potentially violate the principle of beneficence by delaying necessary interventions. Professional Reasoning: Professionals should adopt a systematic approach to informed consent. First, assess the patient’s capacity to understand the information relevant to their medical decision. This involves evaluating their ability to comprehend the condition, proposed treatment, alternatives, and risks, and to appreciate the consequences of their choices. Second, if capacity is present, engage in a clear, comprehensive, and patient-centered discussion, using language tailored to the patient’s understanding. Third, document the informed consent process thoroughly, including the information provided, the patient’s understanding, and their decision. If capacity is questionable, a formal capacity assessment should be conducted, and if the patient lacks capacity, the process should involve appropriate surrogate decision-makers while still respecting the patient’s previously expressed wishes or best interests.

The investigation demonstrates a complex interplay between professional responsibility, ethical considerations, and the practicalities of health systems science within geriatric care. This scenario is professionally challenging because it requires balancing the patient’s autonomy and right to informed consent with the clinician’s duty of care and the potential limitations imposed by the health system. The patient’s cognitive status introduces a significant layer of complexity, necessitating careful assessment of their capacity to understand and make decisions about their care. Health systems science principles are crucial here, as they involve understanding how to navigate resource allocation, interdisciplinary communication, and care coordination to ensure the best possible outcome for the patient within the existing framework. The best approach involves a thorough and documented assessment of the patient’s decision-making capacity. If capacity is present, the clinician must engage in a detailed informed consent process, explaining the proposed treatment, alternatives, risks, and benefits in a manner the patient can understand. This includes utilizing communication aids or involving a trusted family member or advocate as a support, but not as a substitute for the patient’s own decision if they have capacity. This approach upholds the ethical principles of autonomy and beneficence, aligns with professional standards of care, and respects the patient’s right to self-determination. It also demonstrates a commitment to transparent communication, a cornerstone of ethical medical practice. An approach that bypasses a formal capacity assessment and proceeds directly to obtaining consent from a family member, even if the patient is present and appears to be listening, is ethically flawed. This fails to respect the patient’s autonomy if they possess decision-making capacity. It also risks undermining the trust relationship between the patient and the clinician. Another unacceptable approach would be to proceed with treatment without obtaining any form of consent, either from the patient or a surrogate, based solely on the clinician’s judgment of what is best. This violates the fundamental ethical principle of informed consent and could be construed as battery. It also ignores the legal and ethical requirements for patient involvement in their own care. Proceeding with treatment after a cursory discussion with the patient and then informing the family afterward, without a clear capacity assessment or documented informed consent process, is also professionally unsound. This approach prioritizes expediency over ethical diligence and fails to ensure the patient has truly understood and agreed to the proposed course of action. It also creates a risk of miscommunication and potential conflict with the patient or their family. Professionals should employ a structured decision-making process when faced with potential capacity issues. This involves: 1) assessing the patient’s understanding of their condition and proposed treatment; 2) evaluating their ability to weigh the risks and benefits; and 3) determining their capacity to communicate a choice. If capacity is lacking, a legally recognized surrogate decision-maker should be identified and involved in the consent process, always acting in the patient’s best interest. Throughout this process, clear documentation of all assessments, discussions, and decisions is paramount.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between respecting patient autonomy and ensuring their safety and well-being, particularly when cognitive impairment may affect decision-making capacity. The physician must navigate complex ethical considerations and legal requirements regarding informed consent and the management of individuals who may pose a risk to themselves or others, all within the framework of geriatric care standards. Correct Approach Analysis: The best professional practice involves a comprehensive assessment of the patient’s capacity to make decisions regarding their living situation. This includes a thorough evaluation of their cognitive function, understanding of their current circumstances, appreciation of the risks and benefits of different options, and the ability to reason through the consequences of their choices. If capacity is found to be impaired, the physician must then engage with the patient’s designated healthcare proxy or legal guardian, if one exists, to discuss appropriate care plans that prioritize the patient’s safety while respecting their previously expressed wishes or best interests. This approach aligns with ethical principles of beneficence and non-maleficence, as well as legal requirements for informed consent and substituted decision-making when capacity is lacking. Incorrect Approaches Analysis: One incorrect approach would be to immediately override the patient’s stated desire to remain at home without a formal capacity assessment. This disregards the fundamental right to autonomy and could lead to unnecessary distress and a loss of trust. It fails to acknowledge that even individuals with some cognitive decline may retain capacity for specific decisions. Another incorrect approach would be to solely rely on the family’s concerns without independently assessing the patient’s capacity or understanding their perspective. While family input is valuable, the legal and ethical responsibility for determining capacity rests with the physician. Ignoring the patient’s voice or assuming their incapacity based on age or diagnosis alone is discriminatory and unprofessional. A further incorrect approach would be to proceed with arranging alternative living arrangements without exploring all available support services that could enable the patient to remain safely at home. This may involve neglecting to consider home health aides, assistive technologies, or modifications to the living environment, which could be less restrictive and more aligned with the patient’s preferences. Professional Reasoning: Professionals should adopt a systematic approach to capacity assessment. This involves a multi-faceted evaluation, considering the specific decision at hand. If capacity is questionable, a tiered approach to intervention is necessary, starting with less restrictive measures and escalating only as required by safety concerns and in consultation with appropriate parties, including legal counsel or ethics committees if complex situations arise. Documentation of the assessment process and the rationale for decisions is paramount.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate needs of a patient with complex geriatric conditions against the need for comprehensive, evidence-based care that respects patient autonomy and involves appropriate consultation. The physician must navigate potential communication barriers, the patient’s fluctuating capacity, and the ethical imperative to provide the best possible care while adhering to established medical standards and institutional policies. Correct Approach Analysis: The best approach involves a systematic and collaborative process. It begins with a thorough assessment of the patient’s current clinical status, including their cognitive function and ability to participate in decision-making. This is followed by a multidisciplinary team meeting, including geriatric specialists, nurses, social workers, and potentially palliative care or ethics consultants, to develop a comprehensive care plan. Crucially, this plan must be discussed with the patient and their designated surrogate decision-maker, ensuring all options, risks, and benefits are clearly understood. This approach aligns with ethical principles of beneficence, non-maleficence, respect for autonomy, and justice, and is supported by best practices in geriatric care which emphasize interdisciplinary collaboration and patient-centered decision-making. Incorrect Approaches Analysis: One incorrect approach involves unilaterally altering the medication regimen based on a single observation without further investigation or consultation. This fails to acknowledge the complexity of geriatric pharmacotherapy, where changes can have significant unintended consequences due to altered metabolism, polypharmacy, and potential drug interactions. It bypasses essential steps of diagnostic reasoning and collaborative care planning, potentially leading to adverse drug events or suboptimal treatment. Another incorrect approach is to defer all decision-making to the patient’s family without a thorough assessment of the patient’s own wishes or capacity. While family involvement is vital, the primary responsibility for medical decision-making, within the bounds of the patient’s capacity, rests with the patient and their physician. This approach risks overriding the patient’s autonomy and may not fully consider the patient’s best interests if the family’s perspective is not balanced with medical expertise and the patient’s expressed preferences. A third incorrect approach is to delay further intervention until the patient’s condition stabilizes, without actively managing the current symptoms or investigating their cause. Geriatric patients can deteriorate rapidly, and a “wait and see” approach can lead to irreversible decline or prolonged suffering. It neglects the duty to provide timely and appropriate care and fails to proactively address potential reversible causes of the patient’s distress. Professional Reasoning: Professionals should approach such situations by prioritizing a structured, evidence-based, and patient-centered methodology. This involves: 1) Comprehensive Assessment: Thoroughly evaluating the patient’s physical, cognitive, and psychosocial status. 2) Multidisciplinary Collaboration: Engaging all relevant healthcare professionals to gain diverse perspectives and expertise. 3) Shared Decision-Making: Actively involving the patient and their surrogate in discussions, ensuring understanding and respect for their values and preferences. 4) Ethical Consideration: Continuously evaluating decisions against core ethical principles. 5) Documentation: Meticulously recording assessments, discussions, and care plans.