Advanced care decision making: asking the right people the right questions

Aging often includes chronic disability and/or acute periods of illness. When seriously ill, people may be less able to participate in decision making. Decision making capacity, the ability to give informed consent or informed refusal, may not be accurately assessed or may not be assessed at all. Nurses are often ideally positioned to contribute to decision making by the clinical team and with the patient. Understanding how to assess capacity, and when and how to integrate surrogates into clinical decision making, can contribute to improved patient care. An example is used to explore the process of decision making based on medical indications, patient preferences, and the appropriate roles and responsibilities of the health care team and a surrogate decision maker.