Massachusetts General Hospital, Boston, MA, USA.
Hebrew Senior Life, Boston, MA, USA.
Patient. 2020 Dec;13(6):709-717. doi: 10.1007/s40271-020-00447-2.
Divergent objectives and narratives among members of a healthcare team may lead to suffering, underscoring the need to align patient care with the patient's self-identified priorities and goals. Shared decision making (SDM) with patients who may not be able to make healthcare decisions for themselves presents a unique challenge to healthcare providers, caregivers, and patients. Children and the elderly are two such groups where substituted decision making is often required. Family meetings, wherein stakeholders in a patient's care are gathered, present opportunities to align expectations and clinical goals. There is a clear need for a technique exploring all facets of the patient's story within the context of the biopsychosocial-spiritual model. We sought to promote narrative equity among stakeholders and maintain patient focus during family meetings. We describe the use of Mind Mapping in the family meeting to meet these objectives.
Using two clinical scenarios, one involving a geriatric patient and another involving a pediatric patient, we describe the stepwise development of Mind Maps and how their use informed discussions among stakeholders in the family meeting.
Stakeholders found the Mind Maps easy to draw and helpful in eliciting their own priorities and preferences. Group exploration and refinement of the Mind Maps helped stakeholders to appreciate others' sometimes divergent perspectives, to ensure that the patient's voice was heard, and to ensure that care decisions were patient focused.
Mind Mapping was easily performed in two clinical scenarios, allowing the patient, family, and medical team to explore the biopsychosocial-spiritual model extensively, to appreciate each stakeholder's priorities, and to identify areas for further development. We have found that Mind Mapping helps define the 'topography' of relationships, prioritizes team discussions, finds shared interests in seemingly divergent objectives, and identifies which team member may best lead a discussion on a particular topic.
Mind Mapping may be a useful tool for family meetings, particularly for geriatric and pediatric patients with multiple stakeholders involved.
医疗团队成员之间目标和叙述的分歧可能导致患者痛苦，这凸显了将患者护理与患者自我确定的优先事项和目标保持一致的必要性。与可能无法自行做出医疗决策的患者进行共同决策 (SDM) 给医疗保健提供者、护理人员和患者带来了独特的挑战。儿童和老年人就是这样两个需要替代决策的群体。在患者护理的利益相关者聚集的家庭会议中，存在着协调期望和临床目标的机会。在生物心理社会精神模型的背景下，探索患者故事的各个方面显然需要一种技术。我们试图在家庭会议中促进利益相关者之间的叙事公平并保持对患者的关注。我们描述了在家庭会议中使用思维导图来实现这些目标。
使用两个临床场景，一个涉及老年患者，另一个涉及儿科患者，我们描述了思维导图的逐步开发以及它们在家庭会议中如何帮助利益相关者进行讨论。
利益相关者发现思维导图易于绘制，并有助于引出他们自己的优先事项和偏好。对思维导图的集体探索和细化有助于利益相关者理解其他人有时不同的观点，确保患者的声音被听到，并确保护理决策以患者为中心。
思维导图在两个临床场景中都易于执行，允许患者、家属和医疗团队广泛探索生物心理社会精神模型，了解每个利益相关者的优先事项，并确定进一步发展的领域。我们发现思维导图有助于定义关系的“地形”，优先考虑团队讨论，在看似不同的目标中找到共同利益，并确定哪位团队成员可能最适合就特定主题进行讨论。
思维导图可能是家庭会议的有用工具，特别是对于涉及多个利益相关者的老年和儿科患者。
