Decision Aids - Artificial Hydration, CPR, Tube Feeding, and Ventilator

Decision Aids from the Coalition for Compassionate Care of California, certified by AMDA-The Society for Post-Acute and Long-Term Care Medicine

Certification Process

AMDA – The Society for Post-Acute and Long-Term Care Medicine, uses criteria adapted from the National Standards for the Certification of Patient Aids Final Report (December 15, 2016) from the National Quality Forum to certify Decision Aids. Content is reviewed by members our Clinical Practice Steering Committee, Ethics subcommittee, Executive Board of Directors, and Director of Clinical Affairs.

Patient decision aid (PDA) certification criteria

These four decision aids have been certified by AMDA-The Society for Post-Acute and Long-Term Medicine: Artificial Hydration, CPR, Tube Feeding, and Ventilator. The date of certification is April 29, 2022. Any substantive changes made to these decision aids will require a new certification by AMDA.  A full description of AMDA’s certification process and criteria is below.


The following criteria were used by AMDA clinical affairs staff and the Chair of the Clinical Practice Steering Committee to determine certification for each of four decision aids: Artificial Hydration, CPR, Tube Feeding, and Ventilator. The certification was also approved by AMDA’s Executive Board of Directors. Unless otherwise noted, the responses to each of the criteria questions below apply to all four patient decision aids, as each aid follow the same basic format.

Do the PDAs adequately:

  1. Describe the health condition or problem? Yes, each aid starts with “What is…?”
  2. Explicitly state the decision under consideration? Yes—in title of each aid
  3. Identify the eligible or target audience? Yes—“This decision aid is for people with serious illness. It can be used to support medical decision-making and conversations about…”
  4. Describe the medically reasonable options available for the decision, including nontreatment? Yes, e.g. “What happens to people who decide NOT to try artificial hydration?”
  5. Describe the positive features of each option (benefits)? Yes—e.g., “How might artificial hydration help a person?”
  6. Describe the negative features of each option (harms, side effects, disadvantages)? Yes—e.g., “How might artificial hydration cause harm?”
  7. Help patients clarify their values for outcomes of options by:
    • Asking patients to consider or rate which positive and negative features matter most to them? Yes, sections titled “How do people decide whether or not to try…” and includes suggestions for topics about which to speak with their medical team. Also includes section on “Who chooses to try…” and “Who chooses NOT to try…”.
    • Describing each option to help patients imagine the physical, social (e.g., impact on personal, family, or work life), and/or psychological effects?
  8. Make it possible to compare features of available options? Not specifically
  9. Show positive and negative features of options in a balanced and unbiased manner? Yes
  10. If outcome probabilities are included, allow comparison across options using the same denominator—N/A
  11. Provide information about the funding sources for development? Yes, “This decision aid was made possible through a grant from the California Health Care Foundation.”
  12. Report whether authors or their affiliates stand to gain or lose by choices patients make using the PDA? Not included
  13. Include author’s/developer’s credentials or qualifications? These are not included directly on the PDAs. Instead, readers are directed to visit the website,, to access references, or email Author information is included on the website.
  14. Provide date of most recent revision (or production)? Yes, all four say “Copyright 2018”
  15. Follow plain language guidelines to ensure understanding of people with low literacy and/or low health literacy skill? Yes


Does the PDA and/or the accompanying external documentation (including responses to the application for certification) adequately:

  • Disclose and describe actual or potential financial or professional conflicts of interest? N/A
  • Demonstrate that the PDA or supporting document report readability levels? Yes, see below.


From website:

The adult Decision Aids were developed by Mary Cadogan, DrPH, RN, GNP, Professor of the University of California, Los Angeles School of Nursing. Literacy content and accessibility was drafted by Rebecca Sudore, MD, Assistant Professor of Medicine at University of California, San Francisco, and was expertly reviewed by academics, POLST physician champions, hospice physicians, social workers, and other experts. Institute for Healthcare Advancement (IHA), an organization that focuses on health literacy, provided consultation on the layout, design and illustration of the Aids.