What are the criteria for determining the best treatment approach to minimize morbidity and mortality for a patient?

Joan's Criteria for Treatment Decision-Making

Joan's criteria are not a formally established medical framework in the provided evidence or standard medical literature. However, based on the comprehensive guideline evidence provided, I can outline the essential criteria that should guide treatment decisions to minimize morbidity and mortality:

Core Assessment Framework

Patient-Centered Factors

• Elicit patient preferences, expectations, and treatment goals before prescribing any intervention, as this forms the foundation of shared decision-making 1
• Assess the patient's desired level of involvement in decision-making without making assumptions about their preferences 1
• Evaluate patient understanding of their condition and ability to comprehend treatment information to ensure informed consent 2
• Document psychosocial concerns including depression, anxiety, and emotional status that may impact treatment adherence and outcomes 2
• Consider cultural factors and health beliefs that influence treatment acceptance and adherence 2

Clinical Assessment Criteria

• Perform comprehensive diagnostic evaluation including pathologic confirmation when applicable to ensure accurate diagnosis 2
• Assess organ-specific function with baseline laboratory tests to guide treatment selection and dosing 2
• Conduct thorough medication history review including current medications and previous treatments to minimize drug interactions 2
• Document allergies and hypersensitivity reactions in detail, including specific reactions, severity, and timing 2
• Identify all comorbid conditions that may affect treatment selection or require dose adjustments 2

Evidence-Based Treatment Selection

• Use the best available evidence when making decisions, integrating clinical expertise with patient values and preferences 1
• Consider the applicability and quality of evidence, particularly study population characteristics, duration, absolute risk reduction, and time horizon to benefit 1
• Recognize that studies in younger patients without multimorbidity may overestimate benefits and underestimate harms in older, complex patients 1
• Be aware that medications like statins and bisphosphonates may only provide benefit to elderly patients with estimated survival greater than five years 1

Risk-Benefit Optimization

• Choose therapies that optimize benefit, minimize harm, and enhance quality of life, particularly in patients with multimorbidity 1
• Consider treatment burden, complexity, and feasibility when selecting interventions 1
• Perform risk stratification to determine appropriate treatment intensity and monitoring frequency 2
• Evaluate the potential for drug interactions with current medications or substances 2
• Assess the risk of treatment-related adverse events based on patient characteristics and comorbidities 2

Practical Implementation Considerations

• Assess patient's ability to adhere to the proposed treatment regimen, considering lifestyle and self-management capabilities 2
• Evaluate insurance coverage and cost considerations to minimize financial barriers to treatment 2
• Establish a monitoring plan to assess treatment response and manage potential side effects 2
• Ensure informational continuity by exploring encounters with other physicians and changes in management over time 1

Multidisciplinary Coordination

• Coordinate care with other healthcare providers involved in the patient's management 2
• Evaluate the need for specialist consultations for complex comorbidities or treatment requirements 2
• Recommend selection of a primary pharmacy to support coordination of self-administered drugs regarding dosage instructions and overall medication regimens 1

Deprescribing Approach (When Applicable)

• Follow a systematic approach when discontinuing medications: identify and prioritize medicines to be discontinued, stop one at a time, consider tapering dosage rather than abrupt cessation, and plan and communicate with patients and caregivers 1

Documentation and Communication

• Define treatment goals and expected outcomes clearly and discuss them with the patient 2
• Use patient decision aids when available to help make preference-sensitive decisions involving trade-offs between benefits and harms 1
• Ensure care plans are tailored to each person, giving them choice and control while recognizing the interrelated nature of multiple conditions 1

Critical Pitfalls to Avoid

Do not assume that relative risk reduction translates to meaningful absolute benefit in individual patients, particularly those with limited life expectancy 1. Avoid prescribing preventive medications to patients whose time horizon to benefit exceeds their estimated survival 1. Never make treatment decisions without exploring patient expectations and objectives 1.