Background General practitioners have an important role in advance care planning (ACP), due to their advanced medical training, long-term relationships with patients, and coordinators of other healthcare professionals. However, previous research has shown how fear of family conflict and legal disputes can impinge on timely initiation of ACP. Mediation is a facilitated process of identifying interests, developing options, exploring alternatives and making decisions, which aligns with the goals of ACP.
Aim This paper explores how health professionals involved in facilitating ACP may integrate components of the mediator’s skill set. We explore
What the GP can do proactively, to reduce the likelihood of decision-making conflict?
How can the GP negotiate decision-making, if and when conflict arises?
Methods The key principles of mediation are explained in the context of a clinical case. Key principles include:
discrimination between ‘positions’ and ‘interests’
use of a seven step process for initiating and facilitating ‘interest-based negotiation’
use of a mapping tool to identify positions, interests and underlying human needs and emotions
Results Eliciting the interests that underly the differing positions in this case can identify common interests and provide leverage for negotiation. Open disclosure of interests (including those of the health professional) can facilitate negotiation and reduce the likelihood of conflict, and legal risk.
Discussion Incorporating components of the mediator’s skill set may assist health professionals in facilitating ACP and promote patient autonomy.
Conclusion Further work is required to assess the ‘value-add’ of adopting this approach when facilitating ACP.
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