Scenario Analysis: This scenario presents a professional challenge rooted in the inherent tension between the imperative to maintain high standards of patient care and the practical constraints of resource allocation within a Mediterranean healthcare system. The audit findings highlight a potential gap in operational readiness for advanced structural heart disease interventions, specifically concerning the availability of specialized equipment and trained personnel. This requires a delicate balance between immediate patient needs, long-term service development, and adherence to regulatory and ethical obligations. Careful judgment is required to ensure patient safety and quality of care are not compromised while also addressing systemic deficiencies. Correct Approach Analysis: The best professional practice involves a transparent and collaborative approach that prioritizes patient safety and systemic improvement. This entails immediately communicating the audit findings to relevant stakeholders, including hospital administration, the structural heart disease team, and potentially regulatory bodies if mandated. The focus should be on developing a phased, evidence-based action plan to address the identified gaps in equipment and personnel. This plan should include realistic timelines, resource requests, and a commitment to ongoing training and competency assessment. Such an approach aligns with ethical principles of beneficence (acting in the best interest of patients) and non-maleficence (avoiding harm), as well as regulatory expectations for quality assurance and continuous improvement in healthcare services. It fosters a culture of accountability and proactive problem-solving. Incorrect Approaches Analysis: One incorrect approach involves delaying the implementation of necessary upgrades and training until a significant adverse event occurs. This is ethically unacceptable as it prioritizes cost-saving or administrative convenience over patient safety, violating the principle of non-maleficence. It also demonstrates a failure to adhere to proactive quality management principles expected by regulatory frameworks. Another incorrect approach is to proceed with complex procedures without adequate equipment or trained personnel, relying solely on the expertise of a few individuals. This poses a direct risk to patients due to potential complications arising from suboptimal conditions and a lack of standardized protocols. It also undermines the principles of team-based care and can lead to burnout among staff. Ethically, it is a breach of informed consent if patients are not fully aware of the limitations. A third incorrect approach is to dismiss the audit findings as overly critical or irrelevant without a thorough internal review and validation. This demonstrates a lack of professional integrity and a disregard for objective quality assessment. It prevents the identification and rectification of potential systemic weaknesses, leaving the service vulnerable and potentially failing to meet established standards of care. Professional Reasoning: Professionals facing such a situation should employ a systematic decision-making process. First, acknowledge and accept the audit findings as a basis for improvement. Second, engage in open communication with all relevant parties to understand the scope of the issues and potential solutions. Third, prioritize actions based on patient risk and regulatory requirements. Fourth, develop a concrete, actionable plan with clear responsibilities and timelines. Fifth, continuously monitor progress and adapt the plan as needed, ensuring ongoing commitment to quality and patient well-being.

This scenario presents a significant ethical challenge stemming from a conflict between patient autonomy, the physician’s duty of care, and the potential for financial gain influencing medical decisions. The core difficulty lies in navigating the patient’s expressed wishes, which may be influenced by incomplete or biased information, against the physician’s professional judgment and the ethical imperative to act in the patient’s best interest, free from undue influence. Careful judgment is required to ensure that the patient’s decision-making capacity is respected while also upholding the highest standards of medical ethics and professional conduct. The approach that represents best professional practice involves a thorough, unbiased assessment of the patient’s condition and treatment options, followed by a comprehensive, transparent discussion with the patient and their family. This includes clearly outlining the risks, benefits, and alternatives to the proposed transcatheter aortic valve implantation (TAVI), as well as addressing any financial incentives or potential conflicts of interest related to the device manufacturer. The physician must ensure the patient fully understands the implications of their choices and is making an informed decision based on accurate medical information, not solely on promotional material or perceived financial benefits. This aligns with the fundamental ethical principles of beneficence, non-maleficence, and patient autonomy, as well as professional guidelines that mandate transparency and avoidance of conflicts of interest. An incorrect approach would be to proceed with the TAVI procedure based primarily on the manufacturer’s enthusiastic endorsement and the potential for future research collaborations, without independently verifying the patient’s suitability and thoroughly exploring all alternative treatments. This fails to uphold the physician’s primary duty to the patient’s well-being, potentially prioritizing institutional or personal gain over optimal patient care. It also neglects the ethical obligation to ensure truly informed consent, as the patient’s understanding may be skewed by the manufacturer’s influence. Another incorrect approach would be to dismiss the patient’s expressed interest in TAVI outright due to the manufacturer’s involvement, without a balanced and objective evaluation of the procedure’s merits for this specific patient. While vigilance regarding potential conflicts of interest is crucial, a blanket rejection of a potentially beneficial treatment based solely on its source of promotion is paternalistic and undermines patient autonomy. The physician must engage with the patient’s preferences and concerns, even if they are initially influenced by external factors, and guide them towards a decision that is medically sound and ethically justifiable. A further incorrect approach would be to proceed with the TAVI procedure while downplaying the potential risks and complications associated with the device, or failing to disclose the financial relationship with the manufacturer. This constitutes a serious breach of ethical conduct and professional integrity. It deceives the patient, compromises their ability to make an informed decision, and erodes trust in the medical profession. Transparency about all relevant factors, including financial ties, is paramount in maintaining ethical medical practice. The professional reasoning process for similar situations should involve a structured approach: first, conduct a comprehensive and objective clinical assessment of the patient’s condition and all available treatment options. Second, identify and disclose any potential conflicts of interest, including financial relationships with device manufacturers or pharmaceutical companies. Third, engage in open and honest communication with the patient and their family, ensuring they understand the risks, benefits, and alternatives in a clear and unbiased manner. Fourth, document the decision-making process thoroughly, reflecting the patient’s informed consent and the physician’s professional judgment. Finally, seek peer consultation or ethical review if there is any doubt or significant ethical complexity.

The audit findings indicate a potential discrepancy in how the Advanced Mediterranean Structural Heart Disease Medicine Board Certification program’s blueprint weighting, scoring, and retake policies are being communicated to candidates. This scenario is professionally challenging because it directly impacts the fairness and transparency of the certification process, potentially leading to candidate dissatisfaction, legal challenges, and damage to the board’s reputation. Ensuring equitable access to information about the examination’s structure and requirements is paramount to upholding professional standards. The best approach involves proactively and transparently disseminating the official blueprint, including detailed weighting of content areas, scoring methodology, and the precise retake policy, through multiple official channels. This includes the board’s official website, candidate handbooks, and direct communication during the application process. This approach is correct because it aligns with ethical principles of transparency and fairness in assessment. It ensures all candidates have equal access to the information necessary to prepare effectively and understand the consequences of their performance, thereby minimizing potential bias or misunderstanding. Adherence to established guidelines for certification bodies, which emphasize clear communication of assessment criteria, is also fulfilled. An approach that relies solely on a brief mention of “exam structure” in a general information session without providing the detailed blueprint is professionally unacceptable. This fails to meet the ethical obligation of transparency, as candidates are not given the specific information needed to understand how their knowledge will be assessed and weighted. This can lead to an uneven playing field, where candidates who happen to glean more information through informal channels have an advantage. Another professionally unacceptable approach is to only provide the retake policy upon a candidate’s failure to pass the examination. This is ethically problematic as it withholds crucial information that could influence a candidate’s preparation strategy and their decision to even undertake the examination. It also creates an environment of uncertainty and potential disadvantage for those who might have benefited from knowing the retake conditions beforehand. Finally, an approach that vaguely describes scoring as “based on overall performance” without detailing the weighting of specific sections or the passing threshold is also unacceptable. This lack of specificity undermines the principle of fairness in assessment. Candidates cannot effectively gauge their strengths and weaknesses or tailor their study efforts without understanding how different components of the exam contribute to the final score. This opacity can lead to feelings of arbitrariness and unfairness. Professionals involved in certification processes should adopt a decision-making framework that prioritizes candidate rights and the integrity of the examination. This involves a commitment to clear, comprehensive, and accessible communication of all examination-related policies and procedures. Regular review and updating of communication materials to ensure accuracy and clarity, coupled with mechanisms for candidate feedback, are essential for maintaining a fair and reputable certification program.

This scenario presents a professional challenge due to the inherent conflict between promoting a new medical device and ensuring that patient care decisions remain solely based on clinical evidence and patient best interests, free from undue commercial influence. The pressure to adopt a novel technology, even if promising, necessitates a rigorous and unbiased evaluation process. Careful judgment is required to navigate the ethical tightrope of innovation adoption while upholding patient welfare and professional integrity. The best professional approach involves a systematic and evidence-based evaluation of the new device. This includes thoroughly reviewing independent clinical trial data, consulting with peers who have experience with the technology, and considering the device’s potential benefits and risks in the context of established treatment guidelines and individual patient profiles. The decision to adopt or recommend the device should be driven by robust scientific evidence demonstrating superior efficacy, safety, or patient outcomes compared to existing options, and should be integrated into the standard of care only after such validation. This aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as well as professional guidelines that mandate evidence-based practice and transparency. An incorrect approach would be to prioritize the potential for early adoption and the perceived prestige associated with being a pioneer, without sufficient independent validation of the device’s efficacy and safety. This could lead to exposing patients to unproven risks or suboptimal treatments, violating the principle of non-maleficence. Furthermore, accepting significant financial incentives or extensive training directly from the manufacturer without independent critical appraisal of the device’s merits could create a conflict of interest, potentially biasing clinical judgment and undermining patient trust. Another professionally unacceptable approach is to dismiss the new device solely based on its novelty or the fact that it is a new entrant to the market, without a fair and objective evaluation of its potential benefits. This could lead to withholding potentially superior treatment options from patients, thereby failing to uphold the principle of beneficence. Professionals should employ a decision-making framework that begins with identifying the clinical need, followed by a comprehensive search for evidence regarding available treatment options, including novel ones. This evidence should be critically appraised for its quality and relevance. Discussions with colleagues and consideration of patient preferences and values are crucial. Any potential conflicts of interest must be identified and managed transparently. The ultimate decision should always be grounded in the best available evidence and tailored to the individual patient’s circumstances, ensuring that innovation serves, rather than dictates, patient care.

The audit findings indicate a potential deficiency in the candidate preparation resources and timeline recommendations for the Advanced Mediterranean Structural Heart Disease Medicine Board Certification. This scenario is professionally challenging because it directly impacts the integrity of the certification process and the future competence of aspiring specialists. Ensuring that candidates receive adequate, appropriate, and timely preparation is an ethical imperative for the certifying body, as it safeguards patient safety and upholds professional standards. Careful judgment is required to balance the need for rigorous preparation with the practical realities faced by busy clinicians. The best approach involves a thorough review of existing candidate preparation resources and a data-driven reassessment of recommended timelines. This includes soliciting feedback from recent candidates and experienced practitioners, benchmarking against similar international certifications, and consulting with subject matter experts in structural heart disease and medical education. The recommended timeline should be evidence-based, considering the complexity of the subject matter, the typical learning curves for advanced procedural skills, and the need for practical experience. This approach is correct because it prioritizes a systematic, evidence-based, and stakeholder-informed process, aligning with the ethical obligation to provide a fair and effective certification pathway. It ensures that recommendations are not arbitrary but grounded in best practices and the realities of advanced medical training, thereby upholding the credibility of the certification. An approach that relies solely on anecdotal evidence from a small, unrepresentative group of past candidates is professionally unacceptable. This fails to account for potential biases in feedback and may not reflect the needs of the broader candidate pool. It also risks perpetuating outdated or insufficient preparation strategies, potentially disadvantaging future candidates and compromising the quality of the certification. Another unacceptable approach would be to arbitrarily shorten the recommended preparation timeline without any supporting data or expert consensus. This could lead to candidates feeling inadequately prepared, increasing the risk of examination failure and potentially impacting their confidence and future practice. It disregards the ethical responsibility to ensure candidates have sufficient time to master the complex knowledge and skills required for advanced structural heart disease medicine. Finally, an approach that focuses exclusively on increasing the volume of study materials without considering their quality, relevance, or the optimal learning strategies for complex procedural medicine is also professionally flawed. This can lead to information overload and inefficient learning, rather than effective preparation. It fails to address the core issue of whether the current resources and timelines are conducive to deep understanding and skill acquisition. The professional reasoning process for such situations should involve: 1) Acknowledging the audit finding and its potential implications. 2) Forming a multidisciplinary working group including subject matter experts, medical educators, and representatives of the candidate pool. 3) Conducting a comprehensive needs assessment, gathering both qualitative and quantitative data on current preparation resources and candidate experiences. 4) Benchmarking against recognized international standards for similar advanced medical certifications. 5) Developing evidence-based recommendations for resources and timelines, with clear justification. 6) Implementing a feedback mechanism for ongoing evaluation and refinement of the preparation pathway.

This scenario presents a professional challenge due to the inherent conflict between patient autonomy, the physician’s duty of care, and the potential for financial influence on clinical decision-making. The physician must navigate these competing interests while upholding the highest ethical standards and ensuring patient well-being remains paramount. Careful judgment is required to balance the desire to offer innovative treatments with the responsibility to provide unbiased, evidence-based care. The best approach involves a transparent and collaborative discussion with the patient, focusing on presenting all available evidence and treatment options, including the investigational therapy, in a balanced and objective manner. This approach prioritizes informed consent and patient autonomy by empowering the patient to make a decision based on a complete understanding of the risks, benefits, and uncertainties. It also upholds the physician’s ethical obligation to act in the patient’s best interest, free from undue influence. The physician should clearly articulate that participation in the trial is voluntary and that standard-of-care treatments are also viable options. This aligns with principles of beneficence, non-maleficence, and respect for autonomy, as well as professional guidelines emphasizing transparency in research and clinical practice. An approach that emphasizes the investigational therapy without fully disclosing its experimental nature and potential limitations, while downplaying established treatments, is ethically unsound. This fails to provide the patient with a truly informed basis for decision-making and could be construed as coercive, prioritizing potential research gains or institutional interests over the patient’s immediate well-being. It violates the principle of honesty and could lead to a breach of trust. Another ethically problematic approach is to dismiss the investigational therapy outright due to the physician’s personal reservations or perceived conflicts of interest, without a thorough and objective evaluation of its potential merits for the specific patient. This paternalistic stance infringes on patient autonomy and may deprive the patient of a potentially beneficial treatment option, failing the duty of beneficence. Finally, an approach that focuses solely on the financial incentives associated with the investigational trial, without adequately addressing the clinical aspects and patient’s individual needs, is unacceptable. This prioritizes financial gain over patient care and undermines the integrity of the physician-patient relationship. It raises serious concerns about conflicts of interest and potential exploitation. Professionals should employ a decision-making framework that begins with identifying the core ethical principles at play (autonomy, beneficence, non-maleficence, justice). They should then gather all relevant information, including clinical data, patient preferences, and potential conflicts of interest. Open and honest communication with the patient is crucial, ensuring they understand all options, risks, and benefits. Finally, the decision should be made collaboratively, with the patient’s informed consent as the ultimate guiding factor.

The audit findings indicate a potential breach of patient confidentiality and informed consent protocols within the structural heart disease program. This scenario is professionally challenging because it pits the immediate need to improve patient outcomes and program efficiency against the fundamental ethical and legal obligations to protect patient privacy and ensure autonomous decision-making. The pressure to share data for research and quality improvement must be balanced with stringent data protection measures. The best approach involves obtaining explicit, informed consent from patients for the use of their anonymized or pseudonymized data in audits and research, while also ensuring robust data security and de-identification processes are in place. This aligns with the principles of patient autonomy, beneficence (by contributing to improved care), and non-maleficence (by preventing harm through data breaches). It also adheres to data protection regulations that mandate consent for data processing, especially for sensitive health information. The program should have clear, documented policies for data handling, anonymization, and consent, which are regularly reviewed and updated. An incorrect approach would be to proceed with data analysis and sharing without obtaining explicit patient consent, even if the data is intended to be anonymized. This violates the principle of patient autonomy and potentially breaches data protection laws, which require a legal basis for processing personal health data. Another incorrect approach is to rely solely on the assumption that anonymization is sufficient without a clear, documented consent process. While anonymization is a crucial step, it does not negate the ethical and legal requirement for consent, particularly when the data originates from specific patient cases. Furthermore, sharing identifiable patient data with external parties without explicit consent, even for research purposes, constitutes a severe breach of confidentiality and trust, leading to significant legal and reputational damage. Professionals should adopt a decision-making framework that prioritizes patient rights and regulatory compliance. This involves proactively establishing clear protocols for data collection, storage, anonymization, and consent. When faced with a situation like this, the first step is to halt any unauthorized data use and immediately review existing policies. If policies are inadequate, they must be revised to incorporate explicit informed consent mechanisms and stringent data security measures. Regular training for staff on these protocols and ethical considerations is essential. Transparency with patients about how their data is used, and providing them with control over that use, should be a cornerstone of the program’s operations.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between resource limitations and the ethical imperative to provide optimal patient care. The physician must navigate the pressure to adhere to institutional protocols and cost-effectiveness while ensuring that diagnostic decisions are driven by clinical necessity and patient benefit, not solely by budgetary constraints. This requires a nuanced understanding of diagnostic reasoning, imaging selection, and interpretation workflows, grounded in ethical principles and professional guidelines. Correct Approach Analysis: The best professional approach involves a systematic, patient-centered diagnostic reasoning process that prioritizes the most appropriate imaging modality based on the specific clinical presentation and suspected pathology. This begins with a thorough clinical assessment, followed by the selection of imaging that offers the highest diagnostic yield for the suspected condition, considering factors such as resolution, contrast enhancement, and the ability to visualize specific anatomical structures or functional parameters relevant to structural heart disease. Interpretation must then be performed by a qualified specialist, integrating imaging findings with the clinical context to formulate a diagnosis and guide management. This approach aligns with ethical principles of beneficence and non-maleficence, ensuring that diagnostic efforts are both effective and minimize unnecessary patient exposure or cost. It also adheres to professional guidelines that emphasize evidence-based medicine and patient-specific care. Incorrect Approaches Analysis: One incorrect approach involves defaulting to the least expensive imaging modality regardless of its diagnostic adequacy for the suspected structural heart disease. This fails to uphold the principle of beneficence, as it may lead to delayed or missed diagnoses, potentially harming the patient. It also disregards the professional responsibility to select the most appropriate diagnostic tool for the clinical question at hand, prioritizing cost over diagnostic accuracy. Another incorrect approach is to order advanced imaging without a clear clinical indication or a well-defined diagnostic question, driven by a desire to be exhaustive or to avoid potential future complications. While thoroughness is important, indiscriminate ordering of tests can lead to unnecessary radiation exposure, increased costs, and potential for incidental findings that may cause patient anxiety and further investigations. This approach deviates from the principle of judicious resource utilization and can be considered a failure of professional responsibility to order tests only when clinically warranted. A further incorrect approach is to rely solely on the interpretation of non-specialist personnel for complex structural heart disease imaging. While preliminary reviews may be helpful, the nuanced interpretation of advanced cardiac imaging, particularly in the context of structural heart disease, requires specialized expertise to accurately identify subtle abnormalities, assess functional significance, and integrate findings into a comprehensive diagnostic picture. Delegating this critical step to unqualified individuals compromises diagnostic accuracy and patient safety, violating professional standards of care. Professional Reasoning: Professionals should employ a structured diagnostic reasoning framework. This involves: 1) Clearly defining the clinical question based on patient history, physical examination, and initial investigations. 2) Considering a differential diagnosis for the suspected structural heart disease. 3) Evaluating the diagnostic capabilities of available imaging modalities in relation to the differential diagnosis and the specific clinical question. 4) Selecting the imaging modality that offers the best balance of diagnostic yield, patient safety, and resource utilization. 5) Ensuring interpretation by a qualified specialist. 6) Integrating imaging findings with the overall clinical picture to formulate a diagnosis and guide management. This systematic process ensures that diagnostic decisions are evidence-based, patient-centered, and ethically sound.

This scenario presents a significant professional and ethical challenge because it pits the potential for systemic improvement and resource optimization against the fundamental rights and autonomy of individual patients. The core tension lies in balancing the collective good of improving healthcare efficiency with the duty to provide individualized, patient-centered care and obtain truly informed consent. The pressure to meet performance metrics and demonstrate cost-effectiveness can inadvertently lead to a disregard for the nuances of patient circumstances and preferences, creating a conflict between institutional goals and ethical obligations. The best professional approach involves prioritizing genuine informed consent and patient autonomy, even if it means a slight reduction in immediate study efficiency. This entails a thorough and transparent discussion with each patient about the study’s purpose, procedures, potential benefits, risks, and alternatives, ensuring they understand their right to refuse participation or withdraw at any time without compromising their standard care. This approach aligns with core ethical principles of beneficence (acting in the patient’s best interest), non-maleficence (avoiding harm), and respect for autonomy. Regulatory frameworks, such as those governing clinical research and patient rights, mandate that consent must be voluntary, informed, and specific to the individual. This method upholds the dignity of the patient and ensures that participation is a genuine choice, not a consequence of subtle coercion or misunderstanding. An approach that prioritizes the study’s efficiency by streamlining the consent process, perhaps by using generalized information or assuming patient understanding, is ethically flawed. This fails to respect patient autonomy and can lead to consent that is not truly informed, violating the principle of respect for persons. Patients may agree to participate without fully grasping the implications, leading to potential regret or harm. Another ethically problematic approach would be to exclude patients who might require more time or resources for a comprehensive consent discussion, such as those with cognitive impairments or language barriers, without providing adequate alternative mechanisms for informed consent. This could lead to discriminatory practices and a failure to offer potentially beneficial research opportunities to all eligible individuals, violating principles of justice and equity. Finally, an approach that subtly pressures patients into participation by implying that refusal might affect their ongoing care or access to services is a severe ethical breach. This constitutes coercion and undermines the voluntary nature of informed consent, directly contradicting the ethical imperative to protect vulnerable individuals and uphold their right to make free choices about their medical treatment and research participation. Professionals should employ a decision-making process that begins with identifying the ethical principles at play (autonomy, beneficence, non-maleficence, justice). They must then assess the potential conflicts between these principles and institutional goals. A structured approach to informed consent, tailored to the individual patient’s needs and comprehension level, should be the default. When faced with time or resource constraints, the focus should be on finding ethically sound ways to adapt the consent process, not on compromising its integrity. Open communication with patients, colleagues, and ethics committees is crucial for navigating complex situations and ensuring that patient welfare remains paramount.

This scenario is professionally challenging because it involves a complex interplay of medical necessity, patient autonomy, and resource allocation, all within the context of advanced structural heart disease where treatment options can be invasive and carry significant risks. The physician must navigate the patient’s understanding of their condition and treatment options, the caregiver’s role and potential influence, and the ethical imperative to act in the patient’s best interest while respecting their right to self-determination. Careful judgment is required to ensure that the decision-making process is truly shared and that the patient’s values and preferences are paramount. The best professional approach involves a comprehensive and empathetic discussion that prioritizes patient understanding and autonomy. This includes clearly explaining the risks, benefits, and alternatives to the proposed transcatheter aortic valve implantation (TAVI), using language that the patient and caregiver can readily comprehend. It necessitates actively soliciting the patient’s values, goals of care, and any concerns they may have, and ensuring that the caregiver’s input is supportive rather than directive. This approach aligns with the ethical principles of beneficence (acting in the patient’s best interest), non-maleficence (avoiding harm), and respect for autonomy, which are foundational in medical practice and reinforced by professional guidelines emphasizing informed consent and patient-centered care. The goal is to empower the patient to make a decision that is aligned with their personal values and life circumstances, with the caregiver acting as a supportive resource. An approach that focuses solely on the technical success rates of the procedure without adequately exploring the patient’s personal context or preferences fails to respect patient autonomy. This can lead to a decision that is medically sound but not aligned with the patient’s lived experience or desired quality of life, potentially causing distress and undermining trust. Another incorrect approach involves deferring the decision primarily to the caregiver, especially if the patient has capacity to participate in decision-making. While caregivers are important, the ultimate decision rests with the patient. Over-reliance on the caregiver can disenfranchise the patient and may not accurately reflect the patient’s own wishes or best interests, potentially violating their right to self-determination. An approach that presents TAVI as the only viable option without thoroughly discussing palliative care or conservative management, even if TAVI is the preferred medical recommendation, can be ethically problematic. While the physician has a duty to recommend the best medical treatment, patients also have the right to refuse treatment or opt for alternative management strategies that align with their goals, even if those strategies are not curative. This approach can be perceived as coercive and limits the scope of shared decision-making. Professionals should employ a structured decision-making framework that begins with a thorough assessment of the patient’s medical condition and prognosis. This is followed by a clear, jargon-free explanation of all available treatment options, including their respective risks, benefits, and alternatives. Crucially, this involves actively eliciting the patient’s values, preferences, and goals of care through open-ended questions and attentive listening. The caregiver’s role should be defined as supportive, with their input sought to understand the patient’s needs and wishes, but not to supplant the patient’s decision-making authority. Documentation of the shared decision-making process, including the information provided and the patient’s expressed preferences, is essential.