Decision making in the treatment of acute illness in nursing homes: framing the decision problem, treatment plan, and outcome.

This article investigates the social-cultural factors and other circumstances that influence decision making in the treatment of acute illness in three West Coast nursing homes. Participant observation, in-depth interviews with physicians, nursing staff, nursing home residents, and family members, and event analysis were used to gather data. Using decision-making theory as the theoretical framework, analysis focuses on how internal and external factors influence the decision-making process. Two case studies are used to illustrate how in real-life acute clinical situations, physicians frame decision problems, treatment plans, and expected outcomes in order to persuade residents and their families to comply with their preferred treatment plans.