부산대학교 도서관

1. Assess for decision making capacity prior to goals of care discussions especially involving hospice care. 2. Use a multidisciplinary approach to assess patients with suicidal ideation for goals of care. A key aspect of palliative medicine is assessing patient capacity for medical decision-making and discussing goals of care. When capacity is in question due to severe depression and suicidality, psychiatric evaluation in conjunction with aggressive symptom management may significantly impact quality of life, which in turn impacts medical decision-making. Goals of care discussions encourage shared decision-making and advance care planning. These conversations highlight patient autonomy and aid patients and families in making difficult decisions regarding next steps in medical care. When a depressed patient expresses active suicidal ideation, decision-making capacity (DMC) and judgement may be questioned. We present a case of a patient with serious illness, high symptom burden, and active suicidal ideation who expressed desire for hospice care. After psychiatric consultation and medication adjustment, patient's goals of care changed. A 75yo F with Parkinson's Disease and Major Depressive Disorder was admitted to the hospital from assisted living facility after fall without acute injury. Palliative medicine was consulted for goals of care conversation in the setting of Parkinson's Disease. Patient verbalized suicidal ideation (SI) with an action plan prompting psychiatry consultation to evaluate whether the SI was influencing her decision for hospice care. Patient's psychiatric medications were adjusted. With addition of opioid and increase in Sinemet by palliative and primary teams, patient's chronic pain and tremor improved, thereby improving functional capacity. Before discharge, depressive symptoms improved, and patient no longer verbalized suicidal thoughts. Goals of care discussion was revisited, and patient decided to move forward with full-scope disease-directed care. An adult with capacity can refuse treatment. Discontinuation of life sustaining treatment or opting for hospice care requires careful evaluation of capacity, using 4 abilities (understanding, appreciation, reasoning, and expression of choice). Severe depression with SI can limit a patient's DMC prompting psychiatry assessment with treatment of underlying depression and other stressors. Our patient's management involved a multi-disciplinary approach involving palliative medicine, psychiatry, physical therapy, social work, and hospitalist team. Depression often accompanies serious medical illness. Optimizing psychiatric and symptomatic management promotes improved DMC assessment and exploration of patient wishes. Interdisciplinary Teamwork / Professionalism / Managing Suffering and Distress [ABSTRACT FROM AUTHOR]