title: Shared decision-making at end-of-life is aided by graphical trending of illness severity.
abstract: The Rothman Index (RI) gives a visual picture of patient's condition and progress for the physician and family to view together. This case demonstrates how the RI graph facilitates physician-family communication. An 85-year-old man with normal pressure hydrocephalus and ventriculoperitoneal shunt presented with a subdural haematoma. He required a temporoparietal craniotomy and evacuation of left subdural haematoma, followed by care in an intensive inpatient rehabilitation unit. His course was complicated by aspiration pneumonia, dehydration, renal failure and phenytoin toxicity. During hospitalisation, the patient's RI graph was reviewed daily with his family. The RI provided an unambiguous visualisation of the trend of patient acuity, which depicted the patient's persistent decline in health, and made clear to the family the situation of the patient. This clarity was instrumental in prompting frank discussions of prognosis and consideration of comfort measures, resulting in timely transfer to hospice.
authors.affiliation: Intercoastal Medical Group, Sarasota, Florida, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Bittleman
authors.forename: Alan B
authors.initials: AB
authors.lastname: Solinger
authors.forename: G Duncan
authors.initials: GD
authors.lastname: Finlay
mesh_terms: D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects; D003142:Communication; D003196:Computer Graphics; D003657:Decision Making; D003681:Dehydration / Q000150:complications; D046648:Hematoma, Subdural, Intracranial / Q000150:complications / Q000601:surgery; D017051:Hospice Care; D006801:Humans; D008297:Male; D062072:Patient Acuity; D010672:Phenytoin / Q000009:adverse effects; D011015:Pneumonia, Aspiration / Q000150:complications; D011368:Professional-Family Relations; D051437:Renal Insufficiency / Q000150:complications
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin