This scenario is professionally challenging because it requires a palliative care advanced practice clinician to balance the immediate need for comprehensive patient care with the long-term professional development required to maintain and enhance their expertise in a specialized and evolving field. The pressure to prioritize direct patient care can inadvertently lead to neglecting essential preparation for advanced examinations, potentially impacting both individual career progression and the quality of care delivered by an underprepared practitioner. Careful judgment is required to integrate continuous learning and examination preparation into a demanding clinical workload. The best professional practice involves a structured, proactive approach to candidate preparation resources and timeline recommendations. This entails systematically identifying relevant, up-to-date resources that align with the examination’s scope, such as peer-reviewed literature, professional guidelines from reputable palliative care organizations (e.g., Palliative Care Australia, relevant professional colleges), and established advanced practice textbooks. It also involves creating a realistic, phased study schedule that breaks down the material into manageable segments, allowing for consistent review and consolidation of knowledge over a defined period leading up to the examination. This approach ensures comprehensive coverage, allows for reflection and practice, and mitigates the risk of last-minute cramming, which is often ineffective for complex medical knowledge. This aligns with ethical obligations to maintain professional competence and provide evidence-based care. An incorrect approach involves relying solely on informal recommendations from colleagues without verifying the currency or relevance of the suggested materials to the specific examination syllabus. This can lead to studying outdated or tangential information, wasting valuable preparation time and potentially missing critical updates in palliative care medicine. It also fails to acknowledge the ethical imperative to engage with evidence-based resources. Another incorrect approach is to defer all preparation until immediately before the examination, assuming that existing clinical experience will be sufficient. This overlooks the fact that advanced examinations often test theoretical knowledge, research evidence, and nuanced application of principles that may not be consistently encountered or explicitly articulated in daily practice. This reactive strategy increases stress, reduces the opportunity for deep learning and retention, and can lead to superficial understanding, which is ethically problematic when applied to patient care. A further incorrect approach is to focus exclusively on memorizing facts and figures without engaging with the underlying principles, ethical considerations, and evidence base of palliative and supportive care. While factual recall is necessary, advanced practice requires critical thinking, problem-solving, and the ability to integrate knowledge into complex clinical decision-making. An overemphasis on rote memorization neglects the development of these higher-order cognitive skills, which are essential for effective palliative care and are typically assessed in advanced examinations. The professional decision-making process for similar situations should involve a proactive assessment of examination requirements, a realistic evaluation of personal time constraints, and the development of a personalized, evidence-informed study plan. This plan should be flexible enough to accommodate clinical demands while ensuring consistent progress towards examination readiness. Regular self-assessment and seeking feedback from mentors or study groups can further refine the preparation strategy.

Scenario Analysis: This scenario is professionally challenging because it requires a nuanced understanding of the eligibility criteria for advanced practice examinations in a specialized and sensitive field like palliative and supportive care. Misinterpreting or misapplying these criteria can lead to significant professional setbacks for candidates, including wasted time, resources, and potential damage to their career progression. It necessitates careful consideration of the examination’s purpose and the specific requirements designed to ensure candidates possess the appropriate advanced knowledge and skills. Correct Approach Analysis: The best professional approach involves a thorough review of the official examination guidelines published by the relevant Pan-Asian body overseeing the Critical Pan-Asia Palliative and Supportive Care Medicine Advanced Practice Examination. This includes meticulously examining the stated purpose of the examination, which is to validate advanced competency in palliative and supportive care for practitioners across the Pan-Asian region, and cross-referencing this with the detailed eligibility criteria. These criteria typically encompass specific educational qualifications, documented clinical experience in palliative and supportive care, and potentially evidence of ongoing professional development or research in the field. Adhering strictly to these documented requirements ensures that candidates are assessed fairly and that the examination maintains its integrity and purpose of certifying advanced practitioners. Incorrect Approaches Analysis: One incorrect approach is to assume that general advanced practice qualifications in a related medical field are sufficient without verifying specific alignment with palliative and supportive care. This fails to acknowledge that the examination is specialized and designed to assess a distinct set of advanced competencies. Regulatory failure lies in bypassing the specific requirements set forth for this particular advanced practice certification. Another incorrect approach is to rely on anecdotal information or the experiences of colleagues who may have taken similar, but not identical, examinations. While peer experience can be valuable, it is not a substitute for official documentation. This approach risks misinterpreting or overlooking crucial, specific requirements unique to the Critical Pan-Asia Palliative and Supportive Care Medicine Advanced Practice Examination, leading to a failure to meet the stated eligibility criteria. The ethical failure here is a lack of due diligence in seeking accurate information. A further incorrect approach is to focus solely on the desire to achieve advanced practitioner status without a detailed understanding of the examination’s purpose and the specific skills and knowledge it aims to assess. This can lead to candidates applying without the necessary foundational experience or advanced training, resulting in an unsuccessful application and a misallocation of personal and institutional resources. The professional failure is a lack of strategic planning and understanding of the examination’s role in career development. Professional Reasoning: Professionals should approach examination eligibility by prioritizing official documentation. This involves actively seeking out and thoroughly reading the examination handbook, official website, or any published guidelines from the certifying body. They should then systematically compare their qualifications and experience against each stated requirement. If any ambiguity exists, direct communication with the examination administrators or relevant professional bodies is essential. This methodical and evidence-based approach ensures that decisions regarding eligibility are informed, accurate, and aligned with the professional standards and objectives of the examination.

The efficiency study reveals a common challenge in advanced practice palliative care: balancing timely diagnostic accuracy with resource optimization and patient well-being. This scenario is professionally challenging because it requires the advanced practitioner to navigate complex clinical presentations, consider the potential impact of diagnostic interventions on a fragile patient population, and adhere to evolving best practices in imaging selection and interpretation within the Pan-Asian context. Careful judgment is required to avoid unnecessary investigations that could cause distress or financial burden, while ensuring that critical diagnoses are not missed. The best approach involves a systematic, patient-centered workflow that prioritizes clinical relevance and minimizes patient burden. This begins with a thorough clinical assessment to formulate a differential diagnosis, followed by the selection of imaging modalities that are most likely to yield diagnostically useful information for the specific clinical question, considering the patient’s overall condition and goals of care. Interpretation must then be integrated back into the clinical picture, with clear communication to the patient and care team. This aligns with ethical principles of beneficence and non-maleficence, ensuring that diagnostic efforts are proportionate to the potential benefit and do not cause undue harm. It also reflects a commitment to evidence-based practice, utilizing imaging judiciously. An approach that immediately orders a broad range of advanced imaging without a clear clinical indication fails to uphold the principle of proportionality. This can lead to incidental findings that cause anxiety and necessitate further, potentially invasive, investigations, thereby violating the principle of non-maleficence. It also represents a potential misuse of healthcare resources. Another unacceptable approach is to rely solely on basic imaging without considering the limitations when a more specific diagnosis is suspected, or to delay interpretation and integration of findings into the clinical context. This can lead to missed diagnoses or delayed treatment, which is contrary to the duty of care and the principle of beneficence. A further problematic approach is to delegate interpretation without ensuring adequate oversight or integration with the referring clinician’s assessment, potentially leading to miscommunication or a failure to act on critical findings in a timely manner. This undermines the collaborative nature of patient care and can compromise patient safety. Professionals should employ a decision-making framework that begins with a comprehensive clinical assessment, including a detailed history and physical examination, to generate a focused differential diagnosis. This guides the selection of the most appropriate diagnostic test, considering factors such as diagnostic yield, invasiveness, cost, and patient preferences. Following the test, interpretation should be performed by a qualified professional and critically integrated with the clinical findings. Open communication with the patient and the interdisciplinary team is paramount throughout the process.

Scenario Analysis: This scenario presents a professional challenge rooted in the inherent complexities of advanced practice in palliative and supportive care within a Pan-Asian context. The core difficulty lies in navigating diverse cultural expectations regarding end-of-life care, family involvement, and communication styles, while simultaneously adhering to the ethical principles of patient autonomy and beneficence. Advanced practitioners must balance the need for culturally sensitive care with the imperative to provide evidence-based medical interventions, often in resource-variable settings. This requires a nuanced understanding of local customs, religious beliefs, and societal norms that may influence patient and family decision-making, potentially diverging from Western bioethical frameworks. The examination’s orientation phase is critical for establishing a shared understanding of these challenges and the expected professional conduct. Correct Approach Analysis: The best approach involves a proactive and collaborative orientation process that explicitly addresses the unique Pan-Asian context of palliative care. This includes dedicating significant time to discussing cultural nuances in communication, family dynamics, and decision-making processes relevant to the region. It should also involve an open forum for participants to share their prior experiences and concerns related to these cultural factors. Furthermore, the orientation should clearly outline the examination’s focus on applying ethical principles within these diverse cultural frameworks, emphasizing the importance of patient-centered care that respects individual values and beliefs. This approach is correct because it directly prepares advanced practitioners for the real-world complexities they will encounter, fostering a culturally competent and ethically grounded practice. It aligns with the professional obligation to provide care that is not only medically sound but also deeply respectful of the patient’s and family’s cultural identity, a cornerstone of effective palliative care. Incorrect Approaches Analysis: Focusing solely on the technical and clinical aspects of palliative care, without acknowledging the cultural context, is an inadequate approach. This failure ignores the profound impact of cultural beliefs on patient preferences, family roles, and communication, leading to potential misunderstandings and suboptimal care. It neglects the ethical imperative to provide culturally congruent care. Adopting a standardized, Western-centric model of palliative care as the default, without adaptation or discussion of regional variations, is also professionally unacceptable. This approach risks imposing external values and practices that may be incompatible with local customs and beliefs, undermining patient autonomy and family involvement. It fails to recognize the diversity within the Pan-Asian region itself. Limiting the orientation to a brief overview of general ethical principles without specific application to the Pan-Asian palliative care setting is insufficient. While ethical principles are universal, their interpretation and application are heavily influenced by cultural context. This approach fails to equip practitioners with the practical tools and understanding needed to navigate these complexities effectively. Professional Reasoning: Professionals should approach exam orientation with a mindset of active learning and critical reflection. The process should involve seeking to understand the specific challenges and expectations of the examination, particularly concerning the application of knowledge in a diverse regional context. This includes engaging with the material presented, asking clarifying questions, and considering how theoretical concepts translate into practical, culturally sensitive actions. A framework for professional decision-making in this context would involve: 1) Identifying the core ethical and clinical principles. 2) Assessing the specific cultural and contextual factors at play. 3) Evaluating potential approaches against both principles and context. 4) Selecting the approach that best balances patient well-being, autonomy, and cultural respect, informed by the orientation’s guidance.

Scenario Analysis: This scenario presents a common yet complex challenge in palliative and supportive care: balancing the patient’s immediate need for symptom relief with the long-term implications of treatment decisions, particularly when evidence-based guidelines may not perfectly align with individual patient circumstances or resource availability. The professional challenge lies in navigating these complexities ethically and effectively, ensuring patient autonomy and well-being are paramount while adhering to best practices and available evidence. Careful judgment is required to integrate clinical expertise, patient values, and the evolving landscape of palliative care. Correct Approach Analysis: The best approach involves a comprehensive assessment of the patient’s current symptoms, functional status, and goals of care, followed by a shared decision-making process with the patient and their family. This includes a thorough review of the latest evidence-based guidelines for managing the specific symptoms (e.g., pain, dyspnea, nausea) and discussing the potential benefits, risks, and alternatives of various pharmacological and non-pharmacological interventions. The chosen management plan should be individualized, prioritizing symptom control and quality of life, and regularly reviewed and adjusted based on the patient’s response and evolving needs. This aligns with ethical principles of beneficence, non-maleficence, and respect for patient autonomy, as well as professional standards that emphasize patient-centered care and evidence-informed practice. Incorrect Approaches Analysis: One incorrect approach involves solely relying on a single, established protocol without considering the patient’s unique presentation or preferences. This fails to acknowledge the individual variability in response to treatment and the importance of patient-centered care, potentially leading to suboptimal symptom management or patient dissatisfaction. It also neglects the dynamic nature of palliative care, where treatment plans often require adaptation. Another incorrect approach is to prioritize the most aggressive or novel treatment options simply because they are available, without a clear evidence base for their efficacy in this specific patient context or without adequately discussing the potential burdens and benefits with the patient. This risks causing unnecessary harm or distress and may not align with the patient’s goals of care, which often focus on comfort and quality of life. A third incorrect approach is to defer all complex treatment decisions to the patient or family without providing sufficient evidence-based information, guidance, and support. While patient autonomy is crucial, it must be exercised with adequate understanding. Failing to offer expert recommendations based on evidence can lead to decisions that are not in the patient’s best interest from a clinical perspective, potentially resulting in prolonged suffering or missed opportunities for effective symptom relief. Professional Reasoning: Professionals should adopt a systematic approach that begins with a thorough patient assessment, including a detailed history, physical examination, and psychosocial evaluation. This should be followed by a comprehensive review of relevant evidence-based guidelines and literature. Crucially, a robust shared decision-making process must be implemented, where the clinician educates the patient and family about their condition, prognosis, and available treatment options, including their respective risks, benefits, and alternatives. The patient’s values, preferences, and goals of care must be central to the decision-making process. The chosen management plan should be flexible, allowing for ongoing monitoring and adjustment based on the patient’s response and evolving needs, ensuring that the care provided is both evidence-informed and highly individualized.

This scenario presents a professional challenge due to the inherent tension between respecting patient autonomy and the clinician’s duty of care, particularly when a patient’s capacity to make decisions is in question. The need to balance these principles requires careful judgment, adherence to ethical guidelines, and understanding of relevant legal frameworks governing end-of-life care and decision-making for incapacitated individuals. The best approach involves a structured assessment of the patient’s capacity, followed by consultation with the designated substitute decision-maker and, if necessary, an ethics committee. This approach is correct because it prioritizes a systematic and ethically sound process. First, it acknowledges the legal and ethical imperative to assess the patient’s capacity to understand and retain information relevant to their treatment, appreciate the consequences of their decisions, and communicate their choice. If capacity is found to be lacking, the next crucial step is to identify and engage the legally recognized substitute decision-maker. This individual is empowered to make decisions in the patient’s best interests, based on the patient’s known wishes or, if those are unknown, on what is deemed to be in the patient’s best interests. In complex or contentious situations, involving an ethics committee provides an additional layer of review, ensuring that all perspectives are considered and that decisions align with established ethical principles and institutional policies. This multi-faceted approach upholds patient rights while ensuring appropriate care is provided in a challenging clinical context. An approach that bypasses a formal capacity assessment and proceeds directly to involving family members without establishing the patient’s inability to make decisions is ethically flawed. It undermines the principle of patient autonomy, as the patient’s own voice and decision-making capacity are not adequately explored or respected. Another incorrect approach would be to unilaterally make decisions based on the clinician’s perception of the patient’s best interests without engaging the legally appointed substitute decision-maker or seeking further ethical guidance. This disregards the legal framework for substitute decision-making and can lead to decisions that do not align with the patient’s values or wishes, potentially causing distress to the patient and their family. Finally, an approach that delays necessary palliative care interventions due to uncertainty about decision-making, without actively pursuing a resolution through capacity assessment and substitute decision-maker engagement, fails the duty of care. Patients in palliative care have a right to comfort and symptom management, and prolonged indecision can lead to unnecessary suffering. Professionals should employ a decision-making framework that begins with a thorough assessment of the patient’s capacity. If capacity is compromised, the framework mandates the identification and engagement of the appropriate substitute decision-maker. In situations of significant ethical complexity or disagreement, seeking consultation with an ethics committee or legal counsel is a critical step to ensure decisions are both ethically sound and legally compliant, always prioritizing the patient’s well-being and dignity.

The assessment process reveals a critical juncture where a candidate’s performance on the Pan-Asia Palliative and Supportive Care Medicine Advanced Practice Examination falls below the passing threshold. This scenario is professionally challenging because it requires a delicate balance between upholding the integrity of the examination process, ensuring patient safety by only certifying competent practitioners, and providing fair and transparent feedback to the candidate. The weighting and scoring policies are designed to objectively measure competency, and retake policies are in place to offer a structured path for remediation and re-evaluation. The best professional approach involves a thorough review of the candidate’s performance against the established blueprint weighting and scoring criteria. This includes verifying that the scoring was accurate and that the candidate’s results, even if below the pass mark, are documented transparently. Subsequently, the candidate should be provided with clear, constructive feedback detailing the specific areas of weakness identified through the scoring process, referencing the blueprint. This feedback should be accompanied by a clear explanation of the retake policy, including any necessary remediation steps, timelines, and the process for re-examination. This approach is correct because it adheres to principles of fairness, transparency, and due process inherent in professional certification. It upholds the examination’s validity by ensuring that only those who meet the defined standards are certified, while also supporting the candidate’s professional development by offering a clear pathway forward. An incorrect approach would be to immediately grant a conditional pass based on the candidate’s perceived effort or potential, without a rigorous review of the scoring against the blueprint. This fails to uphold the integrity of the examination and compromises patient safety by potentially certifying an individual who has not demonstrated the required level of competence. Another incorrect approach is to dismiss the candidate without providing specific, actionable feedback tied to the examination blueprint and scoring. This is ethically problematic as it denies the candidate a clear understanding of their deficiencies and an opportunity for improvement, violating principles of fairness and professional development. Finally, an approach that involves altering the scoring criteria retroactively to accommodate the candidate would fundamentally undermine the validity and reliability of the examination process and is ethically indefensible. Professionals should approach such situations by first consulting the examination’s official policies regarding blueprint weighting, scoring, and retake procedures. They should then objectively apply these policies to the candidate’s performance. Transparency in communication, providing specific feedback linked to the assessment criteria, and clearly outlining the available pathways for re-assessment are paramount. This systematic and policy-driven approach ensures fairness, maintains professional standards, and supports the candidate’s journey towards competency.

This scenario presents a significant professional challenge because it requires balancing resource allocation with the ethical imperative of equitable access to care, particularly within the context of palliative and supportive care. The tension arises from the efficiency study’s findings, which suggest a potential for improved outcomes by focusing resources on specific demographic groups, potentially at the expense of others. This necessitates careful judgment to ensure that any proposed changes do not inadvertently exacerbate existing health inequities or violate principles of justice and non-maleficence. The best professional approach involves critically evaluating the efficiency study’s methodology and conclusions through the lens of population health principles and health equity. This means scrutinizing the data for potential biases, considering the broader social determinants of health that may influence outcomes in different populations, and engaging with diverse community stakeholders to understand their needs and perspectives. The focus should be on identifying strategies that improve overall care quality and access without creating new disparities or disadvantaging vulnerable groups. This approach aligns with ethical principles of justice, which demand fair distribution of resources and opportunities, and beneficence, which requires acting in the best interests of all patients. Furthermore, it adheres to the spirit of population health initiatives that aim to improve the health of entire communities, not just select segments. An approach that prioritizes implementing the efficiency study’s recommendations without further investigation into potential equity impacts is professionally unacceptable. This would represent a failure to uphold the principle of justice by potentially diverting resources away from populations who may already face barriers to care, thereby widening existing health disparities. It also risks violating non-maleficence by potentially causing harm through reduced access or quality of care for certain groups. Another professionally unacceptable approach would be to dismiss the efficiency study entirely without a thorough, evidence-based review. While caution is warranted regarding equity, outright rejection without consideration could mean overlooking genuine opportunities to improve care delivery and resource utilization that could benefit many, including underserved populations. This would be a failure of due diligence and potentially a missed opportunity for positive systemic change. Finally, an approach that focuses solely on the cost-effectiveness of interventions without considering their impact on health equity is also professionally flawed. While financial sustainability is important, it cannot be the sole determinant of care provision, especially in palliative and supportive care where the needs of vulnerable individuals are paramount. This narrow focus neglects the broader ethical and social responsibilities of healthcare providers and systems. Professionals should employ a decision-making framework that begins with a comprehensive understanding of the problem, including the potential benefits and harms of any proposed changes. This involves critically appraising data, considering ethical principles, consulting relevant guidelines and regulations, and engaging in meaningful dialogue with affected communities. The goal is to arrive at solutions that are both effective and equitable, ensuring that all individuals receive the care they need, regardless of their background or circumstances.

This scenario presents a professional challenge due to the inherent conflict between resource allocation, patient autonomy, and the ethical imperative to provide equitable care. Advanced practice clinicians in palliative and supportive care often face situations where limited resources necessitate difficult decisions, requiring a delicate balance between clinical judgment, patient wishes, and systemic constraints. Careful ethical deliberation and adherence to professional guidelines are paramount. The best approach involves a comprehensive assessment of the patient’s clinical needs, prognosis, and personal values, coupled with an open and honest discussion with the patient and their family about available treatment options and their limitations. This approach prioritizes shared decision-making, respecting the patient’s right to self-determination while ensuring that care aligns with their goals and preferences. It also acknowledges the clinician’s responsibility to advocate for appropriate resource allocation within the healthcare system. This aligns with core ethical principles of beneficence, non-maleficence, and respect for autonomy, as well as professional guidelines emphasizing patient-centered care and transparent communication. An approach that solely focuses on the cost-effectiveness of a treatment without fully exploring the patient’s values and preferences is ethically flawed. It risks devaluing the patient’s lived experience and their right to make informed choices about their own body and care, potentially leading to a paternalistic model of care that prioritizes financial considerations over individual well-being. Another ethically unacceptable approach would be to unilaterally deny a requested intervention based on a perceived lack of benefit without engaging in a thorough discussion with the patient and family about their understanding of the benefits and risks, and their personal goals of care. This bypasses the crucial element of informed consent and can erode trust between the patient and the healthcare team. Finally, an approach that prioritizes the wishes of the healthcare institution or payer over the patient’s expressed needs and desires, without a clear and justifiable clinical rationale, is also professionally unacceptable. This can lead to a situation where care is dictated by external pressures rather than by the patient’s best interests, violating principles of patient advocacy and ethical practice. Professionals should employ a structured ethical decision-making process. This typically involves identifying the ethical issue, gathering relevant information (including clinical data, patient values, and available resources), identifying stakeholders, exploring alternative courses of action, evaluating these alternatives against ethical principles and professional guidelines, making a decision, and reflecting on the outcome. Open communication, empathy, and a commitment to patient-centered care are foundational to navigating these complex situations.

The evaluation methodology shows a scenario that is professionally challenging due to the inherent conflict between a patient’s expressed wishes and the perceived best interests of their family, particularly when dealing with end-of-life care and the sensitive nature of palliative medicine. The advanced practice clinician must navigate complex family dynamics, cultural considerations, and the ethical imperative to respect patient autonomy while ensuring compassionate care. Careful judgment is required to balance these competing factors, ensuring that the patient’s voice remains central to decision-making. The best approach involves a hypothesis-driven history taking that prioritizes understanding the patient’s current understanding of their prognosis and their goals of care, coupled with a focused physical examination to assess symptom burden and functional status. This approach is correct because it directly addresses the core principles of patient-centered care and shared decision-making, which are fundamental in palliative medicine. By actively seeking the patient’s perspective and validating their experiences, the clinician builds trust and ensures that interventions are aligned with the patient’s values and preferences. This aligns with ethical guidelines that emphasize respecting patient autonomy and beneficence, ensuring that care is delivered in a manner that respects the patient’s dignity and quality of life. The hypothesis-driven history allows for targeted questioning, efficiently gathering information relevant to the patient’s immediate concerns and future wishes. The high-yield physical examination provides objective data to inform symptom management and prognostication, further supporting the patient’s goals. An incorrect approach involves solely focusing on the family’s expressed desires for aggressive treatment, disregarding the patient’s apparent discomfort and subtle cues of fatigue or disinterest in further interventions. This approach fails to uphold the ethical principle of patient autonomy, as it prioritizes the wishes of others over the individual’s right to self-determination. It also risks causing unnecessary suffering and distress to the patient by pursuing treatments that are not aligned with their values or that offer little prospect of meaningful benefit. Another incorrect approach involves proceeding with a broad, unfocused physical examination without a clear hypothesis derived from the patient’s history. This is inefficient and may lead to the collection of irrelevant data, potentially delaying the identification of key symptoms or issues that are most important to the patient. It also misses the opportunity to engage the patient in a dialogue about their concerns, which is crucial for building rapport and understanding their perspective. A further incorrect approach involves making assumptions about the patient’s wishes based on their age or perceived frailty, without directly engaging them in a conversation about their goals of care. This paternalistic approach undermines patient autonomy and can lead to care that is misaligned with the patient’s true desires, potentially causing regret or distress for both the patient and their family. The professional reasoning process for similar situations should involve a systematic approach: first, establish rapport and create a safe space for open communication with the patient. Second, employ hypothesis-driven history taking, formulating initial hypotheses about the patient’s condition, symptom burden, and goals of care based on initial observations and available information. Third, conduct a targeted, high-yield physical examination to confirm or refute these hypotheses and gather essential clinical data. Fourth, actively listen to and validate the patient’s concerns and preferences, ensuring their voice is central to all discussions. Fifth, engage in shared decision-making with the patient and, as appropriate, their family, presenting options clearly and respecting the patient’s ultimate choices, even when they differ from the family’s desires.