title: Doctor, What Would You Do? An ANSWER for Patients Requesting Advice About Value-Laden Decisions.
abstract: This article presents a previously published framework, summarized in the mnemonic ANSWER (A, Active listening; N, Needs assessment; S, Self-awareness/reflection; W, Whose perspective?; E, Elicit values; R, Respond) for how to respond to the question, "Doctor, what would you do?" when considering medical decisions that are preference-sensitive, meaning there is limited or debatable evidence to guide clinical recommendations, or are value-laden, such that the "right" decision may differ based on the context or values of a given individual. Using the mnemonic and practical examples, we attempt to make the framework for an ethically appropriate approach to these conversations more accessible for clinicians. Rather than a decision rule, this mnemonic represents a set of points to consider when physicians are considering an ethically acceptable response that fosters trust and rapport. We apply this approach to a case of periviable counseling, among the more emotionally challenging and value-laden antenatal decisions faced by providers and patients.
authors.affiliation: Departments of Obstetrics and Gynecology, and btuckere@iupui.edu.
authors.forename: Brownsyne
authors.initials: B
authors.lastname: Tucker Edmonds
authors.affiliation: Medicine, Indianapolis, Indiana; Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, Indiana; and.
authors.forename: Alexia M
authors.initials: AM
authors.lastname: Torke
authors.affiliation: Medicine, Indianapolis, Indiana; Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, Indiana; and.
authors.forename: Paul
authors.initials: P
authors.lastname: Helft
authors.affiliation: Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, Indiana; and Indiana University School of Nursing, Department of Community Health Systems, Indianapolis, Indiana.
authors.forename: Lucia D
authors.initials: LD
authors.lastname: Wocial
mesh_terms: D000066491:Clinical Decision-Making; D037001:Directive Counseling / Q000592:standards*; D006801:Humans