Strategic planning requires a robust understanding of examination policies to ensure fairness, validity, and program integrity. This scenario is professionally challenging because it involves balancing the need to maintain high standards for advanced practice in oncoplastic surgery with the ethical imperative to provide clear, equitable pathways for candidates seeking to demonstrate their competency. Misinterpreting or misapplying blueprint weighting, scoring, and retake policies can lead to candidate dissatisfaction, legal challenges, and damage to the program’s reputation. Careful judgment is required to ensure policies are applied consistently and transparently. The best approach involves a thorough review of the examination blueprint, including the weighting of specific content areas and the established scoring methodology, to determine the candidate’s performance relative to the defined standards. This approach is correct because it directly aligns with the principles of psychometric validity and fairness. The examination blueprint serves as the foundational document for content coverage and relative importance of topics, ensuring that the assessment accurately reflects the knowledge and skills required for advanced practice in oncoplastic surgery. Transparent scoring methodologies, clearly communicated to candidates, uphold ethical standards by providing objective and predictable outcomes. Adherence to established retake policies, which should be clearly defined and consistently applied, ensures equity and provides candidates with a structured opportunity to improve and re-demonstrate competency if initially unsuccessful. This aligns with professional standards for credentialing and certification, emphasizing competence and patient safety. An incorrect approach involves solely focusing on the candidate’s overall pass/fail status without considering the specific areas of weakness identified through the blueprint weighting and scoring. This fails to provide constructive feedback and may lead to a candidate repeating the entire examination without targeted improvement, which is inefficient and potentially demoralizing. Ethically, it misses an opportunity to guide professional development. Another incorrect approach is to deviate from the established retake policy based on anecdotal evidence or perceived extenuating circumstances without a formal, documented process for appeals or accommodations. This undermines the integrity and consistency of the examination process, creating perceptions of bias and unfairness. Regulatory frameworks for certification typically require standardized procedures to ensure equal treatment of all candidates. A further incorrect approach is to adjust the scoring thresholds or weighting of content areas post-examination to accommodate a candidate who did not meet the passing standard. This violates the fundamental principles of standardized testing and compromises the validity of the examination. It suggests a lack of confidence in the initial blueprint and scoring, and it can lead to questions about the program’s commitment to objective assessment. Professionals should employ a decision-making framework that prioritizes transparency, fairness, and adherence to established policies. This involves: 1) Clearly understanding and communicating the examination blueprint, scoring, and retake policies to all candidates *before* the examination. 2) Applying these policies consistently and objectively to all candidates. 3) Establishing a clear and fair process for addressing candidate appeals or requests for accommodations, ensuring that any deviations from standard policy are well-documented and justified. 4) Regularly reviewing and updating policies based on psychometric data and best practices to maintain the validity and reliability of the examination.

The audit findings indicate a need to clarify the foundational principles and eligibility criteria for the Comprehensive North American Oncoplastic Surgery Advanced Practice Examination. This scenario is professionally challenging because advanced practice providers (APPs) in oncoplastic surgery operate at the intersection of surgical expertise and oncological care, requiring a robust understanding of both clinical practice and the regulatory framework governing their advanced roles. Ensuring that candidates meet the examination’s purpose and eligibility requirements is paramount to maintaining patient safety, upholding professional standards, and validating the specialized skills of APPs in this critical field. Careful judgment is required to distinguish between genuine eligibility and superficial alignment with examination goals. The approach that best aligns with the examination’s purpose and eligibility is to ensure candidates possess a documented history of supervised advanced practice experience specifically within oncoplastic surgery settings, demonstrating a clear progression of skills and knowledge acquisition directly relevant to the examination’s scope. This approach is correct because the examination is designed to assess advanced competency in oncoplastic surgery, implying a need for practical, hands-on experience in this subspecialty. Regulatory frameworks and professional guidelines for advanced practice generally emphasize supervised experience and demonstrated competency in a specific clinical area as prerequisites for advanced certification. This ensures that candidates have not only theoretical knowledge but also the practical application skills necessary to provide safe and effective patient care in oncoplastic surgery. An approach that focuses solely on general surgical experience without specific oncoplastic components fails to meet the examination’s purpose. This is ethically and professionally unacceptable because it does not guarantee the candidate has developed the specialized skills and knowledge unique to oncoplastic surgery, which integrates surgical reconstruction with cancer management. Another incorrect approach involves relying on a broad range of oncology experience that does not include surgical intervention or reconstruction. This is professionally unsound as it overlooks the core “oncoplastic” aspect of the examination, which requires proficiency in both cancer treatment and reconstructive surgical techniques. Finally, an approach that prioritizes completion of didactic courses without corresponding supervised clinical practice is insufficient. While education is vital, the examination’s advanced practice designation necessitates demonstrated clinical competence gained through supervised patient care, which cannot be solely achieved through theoretical learning. Professionals should approach eligibility assessment by meticulously reviewing candidate credentials against the explicit stated purpose and requirements of the examination. This involves verifying the nature and duration of clinical experience, ensuring it directly aligns with the specialized demands of oncoplastic surgery. A structured review process, potentially involving peer assessment or a review committee, can help ensure objective evaluation and adherence to established professional standards.

Scenario Analysis: This scenario presents a professional challenge related to the safe and effective use of energy devices during oncoplastic surgery. The core difficulty lies in balancing the need for precise tissue dissection and hemostasis with the potential for unintended thermal injury to critical structures, especially in the context of breast reconstruction where nerves and vessels are delicate and vital for aesthetic and functional outcomes. Ensuring patient safety while achieving optimal surgical results requires meticulous attention to detail, adherence to established protocols, and clear communication among the surgical team. Correct Approach Analysis: The best professional practice involves a comprehensive pre-operative assessment and intra-operative management strategy that prioritizes patient safety and optimal surgical outcomes. This includes a thorough review of the patient’s anatomy, the planned surgical approach, and the specific energy device to be used. During the procedure, the surgeon should employ the lowest effective energy setting, utilize appropriate activation techniques (e.g., intermittent activation, direct visualization), and employ active smoke evacuation. Furthermore, maintaining a clear field of vision and understanding the device’s limitations are paramount. This approach aligns with the principles of patient safety and evidence-based practice, emphasizing minimizing iatrogenic injury and maximizing the benefits of oncoplastic techniques. Regulatory guidelines and professional standards in North America consistently advocate for such a meticulous and safety-conscious approach to surgical procedures, particularly those involving advanced techniques and energy devices. Incorrect Approaches Analysis: One incorrect approach involves relying solely on the surgeon’s experience without a structured pre-operative planning phase or adherence to specific energy device safety protocols. This overlooks the potential for unforeseen anatomical variations or device malfunctions, increasing the risk of thermal injury. Ethically, this approach fails to uphold the principle of non-maleficence by not taking all reasonable precautions to prevent harm. Another unacceptable approach is to use the highest effective energy setting to expedite the procedure, assuming that speed is the primary objective. This disregards the critical need for precise control and can lead to collateral thermal damage to surrounding tissues, nerves, and blood vessels, compromising both oncological margins and reconstructive outcomes. This violates the principle of beneficence by not acting in the patient’s best interest. A further incorrect approach is to neglect active smoke evacuation during energy device use. Surgical smoke can obscure the operative field, potentially leading to inadvertent injury to vital structures. It also poses respiratory risks to the surgical team. Failing to implement this safety measure demonstrates a disregard for both patient safety and occupational health standards, which are often mandated by regulatory bodies. Professional Reasoning: Professionals should adopt a systematic approach to surgical decision-making, particularly when employing advanced techniques and energy devices. This involves: 1) thorough pre-operative planning, including risk assessment and device selection; 2) meticulous intra-operative technique, focusing on precision, controlled energy application, and active safety measures like smoke evacuation; and 3) continuous vigilance and adaptation based on intra-operative findings. Adherence to established guidelines from professional organizations and regulatory bodies is essential to ensure the highest standard of patient care and minimize potential complications.

Scenario Analysis: This scenario is professionally challenging due to the inherent unpredictability of trauma, the critical need for rapid, evidence-based intervention, and the potential for significant patient harm if protocols are not followed. The oncoplastic surgeon, while skilled in reconstructive techniques, must also possess a robust understanding of immediate life-saving measures and the collaborative nature of critical care. The pressure to act decisively while adhering to established guidelines, often in a high-stress environment with limited resources, demands careful judgment and a commitment to patient safety above all else. Correct Approach Analysis: The best professional practice involves immediate activation of the hospital’s established trauma resuscitation protocol, prioritizing ABCDE (Airway, Breathing, Circulation, Disability, Exposure) assessment and management. This approach is correct because it aligns with universally accepted emergency medicine principles and is mandated by regulatory bodies and professional organizations (e.g., American College of Surgeons Committee on Trauma, Emergency Nurses Association) that set standards for trauma care. These protocols ensure a systematic, comprehensive evaluation and immediate stabilization of life-threatening injuries, preventing delays in critical interventions and minimizing morbidity and mortality. Ethical considerations of beneficence and non-maleficence are paramount, dictating that the patient receive the most effective and least harmful immediate care, which is precisely what a standardized resuscitation protocol provides. Incorrect Approaches Analysis: One incorrect approach is to immediately focus on the oncoplastic surgical needs of the patient, such as assessing the extent of tissue damage for reconstruction, before a full ABCDE assessment. This fails to address immediate life threats and violates the fundamental principle of trauma care that resuscitation precedes definitive management. Ethically, this prioritizes a later stage of care over immediate survival, potentially leading to irreversible harm or death. It also contravenes regulatory guidelines that emphasize the sequential nature of trauma management. Another incorrect approach is to delay the activation of the trauma team and resuscitation protocols while attempting to gather extensive patient history from family members or pre-hospital personnel. While obtaining history is important, it should not supersede the immediate need for physiological assessment and intervention in a critically injured patient. This approach risks delaying critical interventions, such as airway management or hemorrhage control, and is a failure to adhere to established emergency response frameworks designed for rapid, efficient care. A third incorrect approach involves improvising a resuscitation plan based on individual experience without consulting or adhering to the hospital’s specific trauma resuscitation guidelines. While experience is valuable, standardized protocols are developed through extensive research and consensus to ensure the best possible outcomes for a wide range of trauma presentations. Deviating from these established protocols without a clear, evidence-based rationale can lead to omissions, errors, and suboptimal patient care, violating professional standards and potentially regulatory requirements for adherence to institutional policies. Professional Reasoning: Professionals should utilize a systematic decision-making framework that prioritizes patient safety and adherence to established protocols. This involves: 1) Recognizing the critical nature of the situation and the need for immediate, standardized intervention. 2) Activating the appropriate emergency response system (e.g., trauma resuscitation protocol). 3) Systematically following the ABCDE assessment and management steps. 4) Collaborating effectively with the multidisciplinary trauma team. 5) Documenting all interventions and assessments accurately. 6) Continuously reassessing the patient’s condition and adjusting interventions as needed, always within the framework of established guidelines and ethical principles.

Benchmark analysis indicates that managing complications in oncoplastic surgery requires a nuanced approach that balances immediate patient needs with long-term oncological and aesthetic outcomes, all within a framework of professional responsibility and patient autonomy. This scenario is professionally challenging due to the inherent complexity of oncoplastic procedures, which combine cancer resection with reconstructive techniques. The potential for both oncological compromise and aesthetic dissatisfaction, coupled with the patient’s emotional vulnerability, necessitates careful judgment and clear communication. The best professional practice involves a comprehensive assessment of the complication, including its impact on the surgical margins, the integrity of the reconstruction, and the patient’s overall well-being. This is followed by a detailed discussion with the patient about the nature of the complication, the proposed management plan, and the potential outcomes, ensuring informed consent for any further interventions. This approach aligns with ethical principles of beneficence, non-maleficence, and respect for patient autonomy, as well as regulatory requirements for clear documentation and patient communication. An approach that prioritizes immediate surgical correction without adequately informing the patient about the risks, benefits, and alternatives constitutes a failure to obtain informed consent, a fundamental ethical and regulatory requirement. Similarly, delaying definitive management or opting for a less optimal solution solely to avoid further discussion or intervention disregards the patient’s right to receive timely and appropriate care and can lead to poorer oncological or aesthetic results. Furthermore, a strategy that focuses exclusively on aesthetic concerns while neglecting potential oncological implications would be professionally unacceptable, as it compromises the primary goal of cancer treatment. Professionals should employ a decision-making framework that begins with a thorough evaluation of the complication. This involves considering the patient’s clinical status, the specific nature of the complication, and its implications for both cancer control and reconstructive success. Open and honest communication with the patient is paramount, facilitating shared decision-making. This framework should also include consultation with multidisciplinary teams when necessary and adherence to established best practice guidelines for complication management.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the surgeon’s clinical judgment regarding the optimal oncoplastic approach. Balancing patient autonomy with the surgeon’s duty of care, ensuring informed consent, and navigating potential complications require careful ethical and professional consideration. The advanced nature of oncoplastic surgery further complicates decision-making, as it involves both oncological safety and aesthetic outcomes, necessitating a nuanced understanding of patient goals and surgical capabilities. Correct Approach Analysis: The best professional practice involves a collaborative discussion with the patient, clearly outlining the oncological risks and benefits of each proposed surgical option, including the surgeon’s preferred approach. This discussion should detail the expected aesthetic outcomes, potential complications, and recovery timelines for all viable alternatives. The surgeon must then respectfully address the patient’s concerns and preferences, seeking to align the treatment plan with their values and understanding, while ultimately recommending the safest and most oncologically sound option. This approach upholds the principle of informed consent, respects patient autonomy, and fulfills the surgeon’s ethical obligation to provide the best possible care. Incorrect Approaches Analysis: Proceeding with the patient’s preferred, but oncologically suboptimal, approach without a thorough discussion of risks and alternatives would violate the principle of informed consent and potentially compromise oncological outcomes. This disregards the surgeon’s primary responsibility for patient safety and well-being. Ignoring the patient’s expressed preference and unilaterally deciding on the surgical plan, even if deemed clinically superior by the surgeon, undermines patient autonomy and can lead to dissatisfaction and mistrust. While the surgeon’s expertise is crucial, it must be exercised within a framework of shared decision-making. Delaying the discussion about the patient’s preference until after the surgery has commenced would be a severe breach of ethical conduct and informed consent principles. This approach prevents the patient from making an informed decision about their treatment and is professionally unacceptable. Professional Reasoning: Professionals should employ a shared decision-making model. This involves: 1) Eliciting the patient’s values, preferences, and goals. 2) Presenting all relevant medical information, including risks, benefits, and alternatives, in an understandable manner. 3) Exploring the patient’s understanding and addressing any misconceptions. 4) Collaboratively agreeing on a treatment plan that aligns with both clinical best practices and the patient’s informed choices. When there is a significant divergence, open and empathetic communication is paramount to find common ground or to ensure the patient fully understands the rationale behind the recommended course of action.

The analysis reveals that preparing for the Comprehensive North American Oncoplastic Surgery Advanced Practice Examination requires a strategic and well-resourced approach, particularly concerning the timeline and available preparation materials. This scenario is professionally challenging because advanced practice providers (APPs) often juggle demanding clinical responsibilities with the need for rigorous, specialized examination preparation. The pressure to perform well on such a high-stakes exam, which validates advanced competency in a complex surgical subspecialty, necessitates careful planning to avoid burnout and ensure comprehensive knowledge acquisition. The best approach involves a structured, multi-modal preparation strategy that begins well in advance of the examination date, incorporating a variety of reputable resources. This includes dedicating specific, consistent blocks of time for study, utilizing a combination of foundational textbooks, peer-reviewed literature, online question banks tailored to oncoplastic surgery, and potentially attending review courses or workshops. This method is correct because it aligns with principles of adult learning, which emphasize spaced repetition, active recall, and diverse learning modalities for optimal retention and application of complex information. Furthermore, it respects the need for a balanced approach that integrates study with clinical duties, preventing information overload and promoting sustained engagement. This proactive and comprehensive strategy is implicitly supported by professional development guidelines that encourage continuous learning and mastery of specialized skills. An incorrect approach would be to rely solely on a single, limited resource, such as a single textbook or a short, last-minute cram session. This fails to provide the breadth and depth of knowledge required for an advanced examination and neglects the principles of effective learning. It also risks superficial understanding and an inability to apply knowledge in varied clinical contexts, potentially leading to an ethical failure in demonstrating adequate competency. Another incorrect approach is to postpone preparation until immediately before the examination, driven by the belief that clinical experience alone will suffice. This ignores the specific knowledge gaps that an examination is designed to assess and the structured learning required to bridge them. It also creates undue stress and reduces the effectiveness of any last-minute study efforts, potentially impacting patient care indirectly by compromising the APP’s confidence and knowledge base. Finally, an approach that involves exclusively focusing on practice questions without understanding the underlying principles is also flawed. While practice questions are valuable for assessment and familiarization with exam format, they are insufficient as a sole preparation method. This approach can lead to rote memorization without true comprehension, making it difficult to adapt to novel or complex clinical scenarios presented in the exam, and failing to meet the ethical obligation of demonstrating a deep understanding of oncoplastic surgery principles. Professionals should adopt a decision-making process that prioritizes early planning, resource assessment, and the creation of a realistic study schedule that accounts for clinical demands. This involves identifying key knowledge domains, selecting a diverse range of high-quality preparation materials, and allocating sufficient time for each. Regular self-assessment through practice questions and seeking feedback from mentors or study groups can further refine the preparation strategy.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the patient’s immediate aesthetic concerns with the long-term oncological safety and physiological integrity of the breast. The surgeon must navigate complex anatomical considerations, potential physiological impacts of different surgical techniques, and the ethical imperative to provide the best possible oncological outcome while minimizing morbidity. The patient’s desire for a specific aesthetic outcome, while valid, must be integrated within the framework of sound surgical principles and evidence-based practice. Correct Approach Analysis: The best professional practice involves a thorough preoperative assessment that includes a detailed discussion of the patient’s aesthetic goals, a comprehensive oncological evaluation to determine the extent of disease and suitability for oncoplastic techniques, and a clear explanation of the anatomical considerations and potential physiological sequelae of each surgical option. This approach prioritizes patient safety and oncological clearance by ensuring that the chosen oncoplastic technique is appropriate for the tumor’s location, size, and the patient’s breast anatomy, thereby maximizing the chances of a successful oncological resection and a satisfactory aesthetic result. This aligns with the ethical principles of beneficence and non-maleficence, ensuring that the patient receives the most appropriate care that balances oncological outcomes with functional and aesthetic considerations. Incorrect Approaches Analysis: One incorrect approach involves proceeding with a technique solely based on the patient’s expressed desire for a specific aesthetic outcome without a thorough oncological assessment or consideration of anatomical limitations. This risks compromising oncological margins, leading to potential recurrence, and may result in significant functional impairment or an unsatisfactory aesthetic result due to anatomical mismatch. This fails to uphold the principle of non-maleficence by potentially exposing the patient to unnecessary oncological risk. Another incorrect approach is to rigidly adhere to a standard oncological resection technique that does not incorporate oncoplastic principles, even when the tumor location and patient anatomy would benefit from such an approach. This can lead to significant breast deformity, asymmetry, and a poorer aesthetic outcome, potentially impacting the patient’s quality of life and body image without offering any oncological advantage. This neglects the principle of beneficence by not optimizing the patient’s overall well-being. A further incorrect approach is to recommend a complex oncoplastic technique that is beyond the surgeon’s expertise or the available resources, without adequately informing the patient of the associated risks and the need for specialized care. This can lead to suboptimal outcomes, complications, and a failure to meet the patient’s expectations, violating the principle of informed consent and potentially causing harm. Professional Reasoning: Professionals should employ a decision-making framework that begins with a comprehensive understanding of the patient’s oncological status and anatomical characteristics. This should be followed by an open and honest discussion of all viable surgical options, including their oncological safety, potential aesthetic outcomes, physiological impacts, and associated risks. The patient’s values and preferences should be integrated into this discussion, leading to a shared decision-making process that prioritizes the best overall outcome for the individual patient.

This scenario is professionally challenging because it requires balancing the immediate need to address a patient safety event with the long-term imperative of systemic improvement. The advanced practice provider (APP) must navigate potential interpersonal dynamics, maintain patient confidentiality, and ensure adherence to established quality assurance protocols without compromising the integrity of the review process or fostering a culture of blame. Careful judgment is required to ensure the review is thorough, fair, and ultimately leads to actionable improvements. The best professional approach involves meticulously documenting the event, including all relevant clinical details and the patient’s outcome, and then submitting this information through the established institutional quality assurance and morbidity and mortality (M&M) review channels. This approach is correct because it aligns with the fundamental principles of patient safety and regulatory compliance. Healthcare institutions are mandated by regulatory bodies such as the Centers for Medicare & Medicaid Services (CMS) and professional organizations to have robust quality improvement programs, which include systematic review of adverse events. The M&M process is designed to be a confidential, non-punitive forum for learning from patient care errors and near misses. By utilizing this established pathway, the APP ensures that the event is reviewed by a multidisciplinary team, fostering a comprehensive understanding of contributing factors, including human factors, and leading to the development of evidence-based interventions to prevent recurrence. This process upholds ethical obligations to patient safety and promotes a culture of continuous learning and accountability. An incorrect approach would be to directly confront the surgeon involved without first engaging the formal M&M process. This fails to adhere to established institutional protocols for quality assurance and patient safety reviews. It bypasses the structured, multidisciplinary analysis that is crucial for identifying systemic issues and potential human factors contributing to the event. Furthermore, it risks creating an adversarial situation, potentially hindering open communication and collaboration necessary for effective quality improvement, and may violate institutional policies regarding reporting adverse events. Another incorrect approach would be to discuss the event extensively with colleagues outside of the formal M&M review, particularly in a manner that could be construed as gossip or unprofessional criticism. This violates patient confidentiality and the principles of a fair and unbiased review. Such discussions can create a negative work environment, undermine trust, and do not contribute to the systematic identification and resolution of the root causes of the adverse event. It also fails to leverage the expertise of the multidisciplinary team involved in the formal review process. A third incorrect approach would be to ignore the event, assuming it was an isolated incident or not significant enough to warrant reporting. This is ethically unacceptable and a failure of professional responsibility. Every adverse event or near miss, regardless of perceived severity, presents an opportunity for learning and improvement. Failing to report and review such events directly contravenes the core tenets of patient safety and quality assurance, potentially leaving systemic vulnerabilities unaddressed and increasing the risk of future harm to other patients. The professional reasoning process for similar situations should begin with a commitment to patient safety as the paramount concern. The APP should then identify and follow the established institutional policies and procedures for reporting and reviewing adverse events. This typically involves documenting the event factually and submitting it through the designated quality assurance or M&M channels. Understanding the purpose of these processes – to learn and improve, not to assign blame – is crucial for effective participation. If institutional processes are unclear or perceived as inadequate, seeking guidance from a supervisor or the quality improvement department is the appropriate next step.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the surgeon’s clinical judgment regarding the optimal surgical approach for oncoplastic reconstruction. Balancing patient autonomy with the physician’s duty of care, especially in complex reconstructive surgery where aesthetic outcomes are paramount, requires careful consideration of established ethical principles and professional guidelines. The need to ensure informed consent, patient safety, and the achievement of the best possible functional and aesthetic result necessitates a structured decision-making process. Correct Approach Analysis: The best professional practice involves a thorough discussion with the patient, clearly outlining the oncoplastic surgeon’s recommended approach, detailing the rationale behind it, and explaining how it aligns with achieving the best oncological and aesthetic outcomes. This discussion must include a comprehensive explanation of the risks, benefits, and alternatives to the recommended procedure, as well as a clear articulation of why the patient’s preferred approach might be suboptimal or carry higher risks. This approach upholds the principle of informed consent, ensuring the patient understands the implications of their choices and can make a decision that is both autonomous and medically sound. It prioritizes patient well-being and the surgeon’s professional responsibility to provide the highest standard of care. Incorrect Approaches Analysis: Recommending the patient’s preferred approach without a robust discussion of its potential drawbacks, despite the surgeon’s reservations, fails to adequately inform the patient and could lead to a suboptimal outcome, potentially violating the duty of care. Proceeding with the patient’s preferred method without clearly documenting the surgeon’s concerns and the patient’s understanding of the risks constitutes a failure in clear communication and documentation, which is crucial for patient safety and professional accountability. Dismissing the patient’s concerns outright and insisting solely on the surgeon’s preferred method, without engaging in a collaborative discussion, undermines patient autonomy and can damage the patient-physician relationship, potentially leading to a breach of trust and ethical guidelines. Professional Reasoning: Professionals should employ a shared decision-making model. This involves actively listening to the patient’s concerns and preferences, providing clear and understandable medical information, discussing all viable options with their respective risks and benefits, and collaboratively arriving at a treatment plan that respects patient autonomy while ensuring the highest standard of medical care. Documentation of this process is essential.