This scenario is professionally challenging because it requires navigating complex interpersonal dynamics and differing professional priorities within a high-stakes environment like the operating theater and critical care units. Effective interdisciplinary leadership is crucial for patient safety, optimal resource utilization, and fostering a collaborative team culture. The core of the challenge lies in balancing the immediate needs of surgical procedures with the ongoing management of critically ill patients, ensuring seamless communication and decision-making across different specialties and care settings. The best approach involves proactively establishing clear communication channels and shared decision-making frameworks. This entails convening regular multidisciplinary team meetings that include surgeons, intensivists, anesthesiologists, nursing staff, and allied health professionals. These meetings should focus on anticipating potential challenges, reviewing patient progress, and collaboratively developing care plans. Specifically, this approach prioritizes the establishment of a formal, documented handover process between surgical teams and critical care teams, ensuring all relevant patient information, potential risks, and immediate management plans are clearly communicated. This aligns with ethical principles of patient advocacy and professional responsibility, as well as regulatory guidelines that mandate clear communication and continuity of care to prevent adverse events. It fosters a culture of shared responsibility and mutual respect, essential for effective teamwork in complex surgical and critical care environments. An approach that solely relies on informal communication and ad-hoc discussions between individual team members is professionally unacceptable. This failure to establish structured communication pathways can lead to fragmented care, missed critical information, and delays in decision-making, directly compromising patient safety. It violates the ethical duty to provide competent and coordinated care and contravenes regulatory expectations for robust handover protocols. Another professionally unacceptable approach is to allow the surgical team’s immediate procedural needs to consistently override the established critical care management plans without thorough consultation. While surgical urgency is important, critical care units operate on specific protocols and patient monitoring requirements. Disregarding these without collaborative discussion can destabilize critically ill patients and lead to adverse outcomes. This demonstrates a lack of respect for the expertise of the critical care team and a failure to uphold the principle of patient-centered care, which requires considering the holistic needs of the patient across all care settings. Finally, an approach that centralizes all decision-making authority with the most senior surgeon, without actively seeking input from other disciplines, is also professionally flawed. While surgical leadership is vital, complex patient management in critical care requires the collective expertise of multiple specialists. This hierarchical approach can stifle innovation, alienate team members, and lead to suboptimal decisions by ignoring valuable perspectives from critical care physicians, nurses, and other allied health professionals. It fails to leverage the full potential of the interdisciplinary team and can create an environment of distrust and disengagement, ultimately impacting patient care quality. Professionals should adopt a decision-making framework that emphasizes proactive communication, shared governance, and a patient-centered approach. This involves actively seeking to understand the perspectives and priorities of all team members, establishing clear protocols for communication and escalation, and fostering an environment where concerns can be raised and addressed collaboratively. Regular debriefings and a commitment to continuous improvement are also essential components of effective interdisciplinary leadership.

This scenario presents a professionally challenging situation due to the inherent conflict between a patient’s expressed wishes and the surgeon’s clinical judgment regarding the optimal course of treatment for a complex colorectal condition. Navigating this requires a delicate balance of respecting patient autonomy while ensuring the provision of safe and effective medical care, all within the ethical and legal framework governing medical practice in Latin America. The complexity is amplified by the potential for irreversible consequences and the need for clear, informed consent. The best professional approach involves a comprehensive, multi-faceted discussion with the patient and their family, focusing on shared decision-making. This entails clearly articulating the risks and benefits of both surgical options, including the proposed complex procedure and any less invasive alternatives, even if deemed less ideal by the surgeon. The surgeon must ensure the patient fully comprehends the implications of each choice, including potential complications, recovery timelines, and long-term outcomes. This approach aligns with the ethical principles of beneficence (acting in the patient’s best interest) and autonomy (respecting the patient’s right to self-determination), as well as regulatory requirements for informed consent that mandate a thorough explanation of all viable treatment options and their consequences. An approach that prioritizes immediate surgical intervention based solely on the surgeon’s perceived superiority of the complex procedure, without adequately addressing the patient’s concerns or exploring their understanding, fails to uphold the principle of informed consent. This could lead to a violation of patient autonomy and potentially expose the patient to unnecessary risks if their understanding of the situation is incomplete. Another unacceptable approach would be to dismiss the patient’s expressed preference for a less invasive option without a thorough exploration of the underlying reasons for their preference and a clear explanation of why that option might be suboptimal. This can erode trust and lead to patient dissatisfaction, potentially impacting adherence to treatment. Finally, proceeding with the complex surgery without ensuring the patient has had sufficient opportunity to ask questions and express their concerns, or by pressuring them into a decision, constitutes a significant ethical and regulatory failure. It undermines the collaborative nature of patient care and disregards the patient’s right to make an informed choice about their own body. Professionals should employ a decision-making framework that begins with a thorough assessment of the patient’s clinical condition and preferences. This should be followed by open and honest communication, utilizing clear language to explain complex medical information. The process should be iterative, allowing for multiple discussions and opportunities for the patient to process information and ask questions. Documentation of these discussions and the informed consent process is crucial.

This scenario presents a professionally challenging situation due to the inherent uncertainty in complex surgical cases, the potential for unforeseen complications, and the critical need to balance patient autonomy with the surgeon’s expertise and the availability of resources. The surgeon must navigate these complexities while adhering to the highest ethical and professional standards, ensuring informed consent, and maintaining patient safety. Careful judgment is required to select the most appropriate course of action that respects the patient’s wishes, optimizes their outcome, and upholds the principles of good medical practice. The best approach involves a comprehensive, multidisciplinary discussion with the patient and their family, clearly outlining the risks, benefits, and alternatives of both immediate definitive surgery and a staged approach. This includes presenting the evidence supporting each strategy, acknowledging the limitations of current knowledge, and collaboratively developing a treatment plan that aligns with the patient’s values and goals. This approach is correct because it prioritizes shared decision-making, which is a cornerstone of modern medical ethics and patient-centered care. It ensures the patient is fully informed and empowered to participate in decisions about their treatment, fostering trust and adherence to the chosen plan. This aligns with the ethical principle of autonomy and the legal requirement for informed consent, ensuring the patient understands the implications of their choices. An approach that proceeds with immediate definitive surgery without a thorough discussion of the staged alternative, despite the patient’s expressed concerns about the invasiveness, is professionally unacceptable. This fails to adequately respect patient autonomy and may lead to a violation of informed consent if the patient feels coerced or not fully apprised of all viable options. Another professionally unacceptable approach would be to solely recommend the staged approach without fully exploring the patient’s preferences and understanding their rationale for potentially favoring immediate surgery. This paternalistic stance disregards the patient’s right to make choices about their own body and treatment, even if those choices differ from the surgeon’s initial inclination. Finally, deferring the decision entirely to the patient without providing clear, evidence-based guidance on the risks and benefits of each option would also be professionally unacceptable. While patient autonomy is paramount, surgeons have a duty to provide expert medical advice to facilitate informed decision-making. Leaving the patient to navigate complex surgical choices without adequate professional input undermines their ability to make a truly informed decision. Professionals should employ a decision-making framework that begins with a thorough assessment of the clinical situation and the patient’s overall health. This is followed by an open and honest dialogue with the patient and their family, exploring their values, concerns, and goals. The surgeon should then present all reasonable treatment options, including their respective risks, benefits, and uncertainties, supported by the best available evidence. The decision should be a collaborative one, reached through shared understanding and mutual respect, ensuring the chosen path is the most appropriate for the individual patient.

This scenario presents a professionally challenging situation due to the inherent instability of a patient with severe blunt abdominal trauma and signs of hemorrhagic shock. The critical need for rapid assessment and intervention, balanced against the potential risks of immediate operative intervention without adequate resuscitation, requires careful judgment. The challenge lies in determining the optimal timing and sequence of diagnostic and therapeutic measures to stabilize the patient and identify the source of bleeding, all within a time-sensitive environment. The best professional approach involves initiating aggressive, damage-control resuscitation protocols concurrently with rapid diagnostic imaging. This approach prioritizes immediate life-saving measures such as fluid resuscitation, blood product transfusion, and correction of coagulopathy. Simultaneously, a focused, rapid diagnostic assessment, such as a FAST exam or a portable ultrasound, is crucial to identify gross hemoperitoneum or other immediate surgical emergencies. This integrated strategy aims to stabilize the patient hemodynamically while guiding the decision for operative intervention, if necessary, in a more physiologically prepared state. This aligns with established trauma care guidelines that emphasize early recognition and management of shock and the principle of “resuscitate then operate” when appropriate, minimizing the risks associated with transporting an unstable patient to the operating room. An incorrect approach would be to delay definitive resuscitation efforts while awaiting a comprehensive, time-consuming diagnostic workup, such as a full CT scan of the abdomen and pelvis, before initiating aggressive fluid and blood product administration. This delay in resuscitation can exacerbate hypovolemic shock, leading to further organ dysfunction and a poorer prognosis. Ethically, this approach fails to uphold the principle of beneficence by not acting swiftly to address the immediate life threat. Another incorrect approach would be to proceed directly to exploratory laparotomy without any preceding diagnostic imaging or initial resuscitation. While damage control surgery is a critical component of trauma management, proceeding without even a rapid assessment to confirm the presence and likely source of intra-abdominal bleeding can lead to unnecessary operative morbidity, especially if the bleeding is not intra-abdominal or if the patient is too unstable to tolerate surgery. This approach risks performing a non-therapeutic operation on a critically ill patient, failing to adhere to the principle of judicious use of resources and potentially causing harm. A further incorrect approach would be to focus solely on non-operative management and observation without considering the potential for ongoing occult hemorrhage. While non-operative management is appropriate for stable patients with certain injuries, a patient presenting with signs of hemorrhagic shock requires a high index of suspicion for ongoing bleeding and a readiness to intervene surgically if resuscitation is not effective. This approach fails to recognize the dynamic nature of trauma injuries and the potential for rapid deterioration. The professional decision-making process for similar situations should follow a structured trauma resuscitation protocol, such as ATLS (Advanced Trauma Life Support). This involves a primary survey (Airway, Breathing, Circulation, Disability, Exposure) to identify and manage immediate life threats, followed by resuscitation. Concurrent with resuscitation, a rapid secondary survey and diagnostic evaluation are performed to identify all injuries. The decision for operative intervention is then made based on the patient’s hemodynamic stability, the presence of ongoing hemorrhage, and the nature of the identified injuries, always prioritizing the patient’s physiological status.

This scenario presents a professionally challenging situation due to the immediate and potentially life-threatening nature of a large intra-abdominal hemorrhage following a complex colorectal procedure. The surgeon must balance the need for rapid intervention to control bleeding with the imperative to provide the safest possible care, considering the patient’s physiological status and the potential for further complications. Careful judgment is required to select the most appropriate management strategy, which involves a thorough assessment of the bleeding source, the patient’s hemodynamic stability, and the available resources. The correct approach involves immediate return to the operating room for re-exploration and definitive control of the hemorrhage. This is the best professional practice because it directly addresses the most critical issue: active bleeding. Prompt surgical intervention is essential to prevent hypovolemic shock, organ damage, and potential mortality. This aligns with the ethical principle of beneficence, requiring the surgeon to act in the patient’s best interest by addressing the immediate threat to life. Furthermore, established surgical guidelines and best practices for managing intraoperative complications emphasize prompt and definitive surgical management of uncontrolled bleeding. An incorrect approach would be to attempt conservative management with blood product resuscitation and close monitoring without immediate surgical re-exploration. This fails to address the root cause of the hemorrhage and carries a high risk of patient deterioration, potentially leading to irreversible shock and death. Ethically, this approach violates the principle of non-maleficence by exposing the patient to undue risk through delayed definitive treatment. It also fails to meet the standard of care expected in managing acute surgical bleeding. Another incorrect approach would be to transfer the patient to an intensive care unit for stabilization before re-exploration. While ICU care is crucial for post-operative management, delaying surgical intervention for bleeding of this magnitude is inappropriate. The primary problem is surgical, and delaying definitive control in favor of medical stabilization is a dangerous gamble that could lead to catastrophic consequences. This represents a failure to prioritize the most urgent need and a deviation from established protocols for managing intraoperative hemorrhage. A further incorrect approach would be to proceed with a less invasive diagnostic procedure, such as angiography, before surgical re-exploration. While angiography can be useful in identifying bleeding sources in certain contexts, it is not the primary or most efficient method for managing a large, active intra-abdominal hemorrhage in the immediate post-operative period. The time taken for such a procedure could exacerbate the patient’s condition, and it does not guarantee definitive control of the bleeding. This approach prioritizes diagnostic certainty over immediate life-saving intervention, which is ethically and professionally unsound in this critical situation. The professional decision-making process for similar situations should involve a rapid assessment of the patient’s hemodynamic status, the suspected source of bleeding, and the urgency of intervention. A structured approach, often guided by institutional protocols for managing surgical complications, should be followed. This includes immediate communication with the surgical team, anesthesiology, and nursing staff, followed by a swift decision regarding the most appropriate intervention, prioritizing definitive control of the bleeding.

The scenario presents a professional challenge rooted in the inherent subjectivity of assessing complex surgical skills and the need for a fair, transparent, and consistent evaluation process within a high-stakes fellowship exit examination. The fellowship’s blueprint weighting, scoring, and retake policies are designed to ensure that candidates meet a defined standard of competence. Misinterpreting or misapplying these policies can lead to an unjust evaluation, potentially impacting a candidate’s career trajectory and the reputation of the fellowship program. Careful judgment is required to balance the need for rigorous assessment with fairness to the candidate. The best approach involves a thorough review of the candidate’s performance against the established blueprint, considering all assessment components and their weighted contributions. This includes meticulously documenting any deviations from expected performance and cross-referencing these observations with the fellowship’s explicit scoring rubric and retake criteria. This method ensures that the evaluation is objective, evidence-based, and directly aligned with the program’s stated standards for successful completion. Adherence to the blueprint weighting and scoring guidelines is paramount for maintaining the integrity and validity of the examination process. An approach that relies solely on a general impression of the candidate’s overall performance, without detailed reference to the blueprint weighting and specific scoring criteria, fails to provide an objective basis for the assessment. This can lead to subjective bias and an evaluation that is not defensible against the program’s established standards. Another incorrect approach would be to apply retake policies inconsistently, perhaps based on personal rapport with the candidate or external pressures, rather than the objective criteria outlined in the fellowship’s guidelines. This undermines the fairness and predictability of the examination process. Furthermore, an approach that overlooks or downplays specific areas of weakness identified during the assessment, in favor of highlighting perceived strengths, also deviates from the principle of comprehensive evaluation. The blueprint is designed to identify proficiency across all critical domains, and a failure to address deficiencies rigorously is a disservice to both the candidate and future patients. Professionals should employ a decision-making framework that prioritizes adherence to established protocols and guidelines. This involves: 1) Understanding the assessment blueprint thoroughly, including weighting and scoring. 2) Objectively documenting performance against each component of the blueprint. 3) Applying the scoring rubric consistently and without bias. 4) Consulting the retake policy for clear, objective criteria. 5) Seeking peer review or consultation if there is any ambiguity or significant divergence in assessment. 6) Maintaining clear and transparent communication regarding the assessment process and outcomes.

This scenario is professionally challenging because it requires a fellow to balance the intense demands of advanced surgical training with the need for effective, evidence-based preparation for a high-stakes exit examination. The pressure to perform well on the exam, coupled with the ongoing clinical and operative responsibilities, can lead to suboptimal study habits if not managed strategically. Careful judgment is required to ensure that preparation is comprehensive, efficient, and ethically sound, avoiding burnout and ensuring patient safety is not compromised. The best approach involves a structured, multi-modal preparation strategy that integrates ongoing learning with dedicated study time, informed by the examination’s scope and format. This includes actively engaging with current literature, reviewing case studies relevant to complex colorectal surgery, practicing exam-style questions, and seeking feedback from mentors. This method is correct because it aligns with principles of lifelong learning essential in medicine, promotes deep understanding rather than rote memorization, and acknowledges the practical realities of a busy fellowship. It also implicitly adheres to ethical obligations to maintain professional competence, ensuring the fellow is well-prepared to provide high-quality patient care upon completion of the fellowship. An approach that solely relies on reviewing lecture notes from the fellowship without consulting recent literature or practice questions is professionally unacceptable. This fails to acknowledge the dynamic nature of surgical knowledge and the importance of staying current with advancements, potentially leading to outdated knowledge and an inability to address contemporary clinical challenges. It also neglects the specific format and demands of an exit examination, which often tests application of knowledge in novel scenarios. Another unacceptable approach is to defer all dedicated study until the final weeks before the examination, while continuing with an unadjusted clinical workload. This strategy is likely to lead to superficial learning, increased stress, and a higher risk of burnout. It compromises the depth of understanding required for complex surgical concepts and can negatively impact clinical performance due to fatigue and cognitive overload. Ethically, this approach risks presenting oneself for examination without adequate preparation, potentially jeopardizing patient safety in future practice. Finally, an approach that focuses exclusively on memorizing answers to past examination questions without understanding the underlying principles is also professionally unsound. While familiarity with question formats is useful, this method does not foster true comprehension or the ability to adapt knowledge to new situations. It represents a superficial engagement with the material and fails to equip the fellow with the critical thinking skills necessary for complex surgical decision-making. This approach undermines the purpose of an exit examination, which is to assess comprehensive competence. Professionals should adopt a decision-making framework that prioritizes a balanced and integrated approach to preparation. This involves: 1) Understanding the examination’s blueprint and weighting of topics. 2) Creating a realistic, phased study schedule that incorporates regular review and practice. 3) Actively seeking out and engaging with diverse learning resources, including peer-reviewed literature, case-based discussions, and question banks. 4) Regularly assessing progress and adjusting the study plan as needed. 5) Prioritizing well-being to prevent burnout and maintain optimal cognitive function.

Scenario Analysis: This scenario is professionally challenging because it requires a surgeon to balance the immediate need for surgical intervention with the potential for unforeseen complications in a patient with significant comorbidities. The complexity of the patient’s history necessitates a meticulous pre-operative assessment and a robust plan that anticipates potential intra-operative and post-operative issues. Failure to adequately address these risks can lead to adverse patient outcomes, increased morbidity, and potential medico-legal repercussions. The ethical imperative is to provide the highest standard of care while respecting patient autonomy and ensuring informed consent. Correct Approach Analysis: The best professional practice involves a comprehensive, multi-disciplinary structured operative plan that explicitly addresses the patient’s specific risk factors and outlines clear mitigation strategies. This approach necessitates a thorough review of the patient’s medical history, including detailed consultation with cardiology and pulmonology to optimize pre-operative status. The operative plan should include contingency measures for potential intra-operative bleeding, anesthetic challenges, and post-operative complications such as ileus or wound dehiscence, with clear protocols for managing these events. This aligns with the ethical principle of beneficence, ensuring all reasonable steps are taken to maximize patient benefit and minimize harm, and the principle of non-maleficence, actively avoiding harm. It also supports the professional obligation to maintain competence and provide evidence-based care. Incorrect Approaches Analysis: One incorrect approach involves proceeding with surgery based on a standard protocol without a detailed, individualized risk assessment and mitigation plan tailored to the patient’s specific comorbidities. This fails to uphold the principle of beneficence by not proactively addressing known risks, potentially leading to preventable complications. It also neglects the professional duty to provide personalized care based on a patient’s unique circumstances. Another unacceptable approach is to rely solely on the intra-operative judgment of the surgical team to manage any emergent complications without pre-defined strategies. This demonstrates a lack of structured planning and a failure to anticipate potential adverse events, which is contrary to the ethical obligation to prepare thoroughly for all foreseeable outcomes and the professional standard of meticulous operative planning. A further incorrect approach is to proceed with surgery without obtaining updated consultations from cardiology and pulmonology, despite the patient’s recent cardiac event and respiratory issues. This disregards critical information that could significantly impact anesthetic management and surgical risk, violating the principle of non-maleficence by proceeding without a complete understanding of the patient’s physiological status and potential vulnerabilities. Professional Reasoning: Professionals should adopt a systematic approach to operative planning, beginning with a comprehensive patient assessment that identifies all relevant risk factors. This should be followed by a collaborative development of a detailed operative plan that includes specific strategies for risk mitigation and contingency planning. Regular review and updates of this plan, especially in complex cases or when new information emerges, are crucial. The decision-making process should be guided by ethical principles, regulatory requirements for patient safety, and professional standards of care, always prioritizing the patient’s well-being and informed consent.

The evaluation methodology shows that assessing a surgeon’s clinical and professional competencies requires a multi-faceted approach that goes beyond purely technical surgical skills. This scenario is professionally challenging because it involves a complex interplay of patient autonomy, informed consent, potential for adverse outcomes, and the surgeon’s responsibility to advocate for the patient’s best interests within the bounds of established medical practice and ethical guidelines. The surgeon must balance the patient’s expressed wishes with their own professional judgment regarding the safety and efficacy of proposed treatments, particularly when those wishes deviate from standard care or carry significant risks. The best approach involves a thorough, documented discussion with the patient and their family, exploring the rationale behind the patient’s request, clearly articulating the risks and benefits of both the requested procedure and alternative treatments, and ensuring the patient fully comprehends the implications of their decision. This approach prioritizes shared decision-making, respecting patient autonomy while upholding the surgeon’s ethical obligation to provide safe and appropriate care. It aligns with the principles of informed consent, which mandate that patients receive sufficient information to make voluntary and informed choices about their medical treatment. Furthermore, it reflects the professional duty of care to act in the patient’s best interest, which includes ensuring that any chosen treatment is medically sound and ethically justifiable. An incorrect approach would be to immediately accede to the patient’s request without a comprehensive discussion and assessment of understanding. This fails to uphold the principle of informed consent, as the patient may not fully grasp the risks or alternatives. It also neglects the surgeon’s professional responsibility to guide the patient towards the safest and most effective treatment options, potentially exposing the patient to unnecessary harm. Another incorrect approach would be to dismiss the patient’s request outright due to personal discomfort or a belief that the patient is not making a “good” decision, without engaging in a dialogue to understand their perspective and concerns. This demonstrates a lack of respect for patient autonomy and can erode the trust essential for a therapeutic relationship. It also fails to explore potential underlying reasons for the patient’s request, which might be addressable through further communication or support. Finally, an incorrect approach would be to proceed with the requested surgery without adequate documentation of the informed consent process or consultation with colleagues when uncertainty exists. This leaves the surgeon vulnerable to ethical and professional repercussions if complications arise and demonstrates a failure to adhere to best practices in patient care and risk management. Professionals should employ a decision-making framework that begins with active listening and empathetic engagement with the patient’s concerns and desires. This should be followed by a clear, objective presentation of medical information, including risks, benefits, and alternatives, tailored to the patient’s level of understanding. When there is a significant divergence between the patient’s wishes and the surgeon’s professional judgment, a collaborative approach involving further discussion, seeking second opinions, and involving ethics committees or other support services is crucial. Documentation of all discussions, assessments, and decisions is paramount to ensure accountability and patient safety.

This scenario presents a professionally challenging situation due to the inherent complexity of advanced colorectal surgery and the potential for significant patient morbidity and mortality. The surgeon must balance the immediate need for surgical intervention with the long-term implications for the patient’s quality of life and the ethical imperative to obtain informed consent. Careful judgment is required to ensure that the patient’s autonomy is respected while providing the highest standard of care. The best professional approach involves a thorough preoperative assessment of the patient’s understanding of the proposed surgery, including its risks, benefits, and alternatives. This includes a detailed discussion of the potential for stoma formation, its implications for daily living, and the availability of reconstructive options. The surgeon must ensure that the patient comprehends this information and can make a voluntary decision based on their values and preferences. This aligns with the ethical principles of autonomy and beneficence, and is supported by professional guidelines that mandate comprehensive informed consent processes in complex surgical procedures. An incorrect approach would be to proceed with surgery without adequately assessing the patient’s comprehension of the potential for a permanent stoma. This fails to uphold the principle of patient autonomy, as the patient cannot make a truly informed decision if they do not understand the full scope of potential outcomes. Ethically, this constitutes a breach of informed consent. Another incorrect approach would be to downplay the likelihood or impact of a stoma to alleviate patient anxiety. While well-intentioned, this misrepresents the potential risks and benefits, undermining the informed consent process and potentially leading to patient dissatisfaction and distrust if a stoma is ultimately required. This violates the ethical duty of truthfulness. Finally, proceeding with surgery and only discussing stoma implications postoperatively, especially if a stoma is unavoidable, is also professionally unacceptable. This delays crucial information, preventing the patient from participating in the decision-making process regarding their own body and care. It also fails to allow for adequate psychological preparation and support, which are vital for patients who may require a stoma. Professionals should employ a decision-making framework that prioritizes patient-centered care. This involves a systematic approach to informed consent, ensuring clear communication, active listening, and verification of patient understanding. When dealing with complex surgical procedures with potentially life-altering outcomes, such as the need for a stoma, it is crucial to dedicate sufficient time to these discussions, involve family members if appropriate, and provide written information to reinforce verbal communication. The goal is to empower the patient to make a decision that aligns with their personal values and goals.