Mnemonic Device for Patient Decision-Making Assessed

'CURVES' approach less complex and time-consuming for emergency decisions

FRIDAY, Feb. 12 (HealthDay News) -- Clinicians who must quickly assess a patient's capacity to make an emergency treatment decision can now fall back on a new mnemonic device, "CURVES," developed at Johns Hopkins University and reviewed in the February issue of Chest.

Grant V. Chow, M.D., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues reviewed assessment issues and existing tools, including the MacArthur Competence Assessment Tool for Treatment and the Hopkins Competency Assessment Test, both of which are well validated but may be too complex and time-consuming in an emergency. The authors' CURVES mnemonic device is based on the same capabilities but is easier and faster to implement.

The authors explain that CURVES stands for Choose/Communicate, Understand, Reason, Value, Emergency and Surrogate. Patients must be able to choose among options and communicate their preferences; understand the benefits, risks, alternatives, and consequences; reason their options through and explain their decision, and make a choice consistent with their own values. If the patient cannot meet any of these criteria, the clinician may intervene without explicit patient consent if two other conditions exist: the situation is a true emergency and there are no surrogate decision makers or legal documents containing the patients wishes.

"If a patient is unable, for whatever reason, to exercise informed consent, it is the physician's responsibility to identify an appropriate proxy decision maker, typically a spouse, adult child, or sibling. If no such proxy decision maker is available, the physician must proceed with the patient's best interests in mind," the authors write.

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