CARE: A Model for Doctor-Surrogate Decision Making

Topic: Quality Advance Care Planning

Much has been written about the importance of the “Doctor-Patient” relationship and the obligations it demands. A majority of attention has been paid to the various steps, checklists, and algorithms that providers must follow in order to insure that they allow patients an autonomous voice. Interestingly, though the importance of values such as trust, compassion, and respect are mentioned as vital to this relationship, less attention is given to how to instill and maintain these in practice. Further, while emotion is mentioned as a component of many of these models, it is mostly referenced as merely a reaction to be allowed and affirmed. Finally, the role of family or surrogates in the decision-making relationship is often missed. The CARE Method is an analytical tool to help providers, patients, and families better understand each other’s motivations and attitudes. The method examines the means and content of communication, the affect or mood of those communications, the context and reasoning of each party, and the effect and conclusions of each interaction. In this way, one can achieve a better understanding of the emotional roots of a decision and thus have a positive effect on building and sustaining a therapeutic doctor-patient-surrogate relationship.

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