Value-Concordant Decision Making in Patients on Prolonged Mechanical Ventilation: A Family-Centered Care Approach Using the Calgary Family Assessment and Intervention Models
Bibliographic record
Abstract
Family-centered care (FCC) emphasizes collaboration with family members to build shared understanding and support decision-making. The Calgary Family Assessment Model (CFAM) and the Calgary Family Intervention Model (CFIM) provide a practical structure for translating this approach into family assessment, communication, and tailored family support. A man in his 60s with high cervical (C3/4) spinal cord injury required prolonged mechanical ventilation. Nurses integrated FCC with the CFAM and CFIM through structured family conferences using teach back and circular questioning, CFAM-guided assessment, CFIM interventions across cognitive, affective, and behavioral domains, and an option grid comparing home and facility care. This bedside implementation clarified the core value-time to talk freely with family-and reframed a binary "wean-then-home" assumption into parallel planning. The patient and family chose to discontinue weaning and transfer to a facility with flexible visitation, as this was the best goal, being value-concordant and safe. This integrated approach supported a nonhierarchical partnership and fostered trust, shared understanding, and effective decision making.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".