Table 1 Cross-tabulation illustrating a model of the process of FIMPT decision-making based on a three month non-participant observation
Decision stage | Observation | Description |
|---|---|---|
0. Before the meeting | Not observed | Patient referred from ward or community. Depending upon time of admission and time of referral: the dietician, speech and language therapist, gastroenterologist and other relevant specialists assess the patient. Decision-making capacity is assessed. Treatment options are talked over and explained with the patient and/or next of kin. |
1. Forming the picture | Observed | Background information about the patient’s case is presented by member of the clinical team who knows the patient. Dietetics and speech & language therapy present the results from their assessments |
2. Identifying the problem | Observed | If the reasons for the patient’s referral are apparent and their diagnosis is clear, the discussion can move straight onto stage 3. In complex cases, the Chair and other participants will ask further questions of the person presenting the case, the speech and language therapist, dietician and anyone else who has examined the patient. |
3. Discussion | Observed | A deeper conversation about potential treatments and interventions. Conversation seeks to balance risks and benefits, other clinical issues, and includes ethical and social concerns. At this stage, the discussion has a less structured format. Stage 3 continues until the weight of evidence for a particular treatment option or course of action becomes apparent. |
4. Outcome and planning | Observed | The Chair states the outcome of decision-making process and a brief discussion of treatment scheduling and planning follows. For some patients the outcome involves direct patient assessment by one of the FIMPT clinicians, this may include referral to palliative care or medicine for the elderly teams to assist in all future management not only management of nutrition. |
5. After the meeting | Not observed | The recommendations from the meeting are presented back to the patient and/or next of kin by the treating team who have presented the patient at the meeting. Further discussions and decision-making take place. Relevant scheduling and planning takes place. The treating team return to the next meeting for further discussion if additional questions arise or if the patient’s condition changes. |