Patient Preferences and Decision Making
Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.
What has your experience been with patient involvement in treatment or healthcare decisions?
In this Discussion/Essay below, they share their experiences and the impact of patient involvement (or lack of involvement). They consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.
• Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
• Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.
o Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.
NOTE: To ensure compliance with HIPAA rules,they did NOT use the patient’s real name or any information that might identify the patient or organization/practice.
In the Discussion/Essay below, a brief description of the situation they experienced and they explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, they explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, they explain the value of the patient decision aid they selected and how it might contribute to effective decision making, both in general and in the experience you described. They described how they might use this decision aid inventory in your professional practice or personal life.
Using the Discussion/Essay below, respond and offer alternative views on the impact of patient preferences on treatment plans or outcomes, or the potential impact of patient decision aids on situations like the one shared.
DISCUSSION/ESSAY THAT YOU NEED TO REPLY:
Incorporating Patient Preferences and Values in Treatment Plan
In this day and age, when healthcare has evolved into patient-centered care and the use of the evidence-based practice, patients do not comfortably rely on only providers’ supply of information concerning their health. They want to collaborate with healthcare providers in decision-making and control their health and wellness (McGonigle & Mastrian 2022). In my nursing career and as an advocate, most of my patients and their families are allowed to contribute to the treatment decision-making. I have advocated for shared decision-making, whereby patients are adequately educated on the benefits and consequences of the treatment and other treatment options and are jointly involved in the decision-making while honoring their preferences and values (Hoffman, Montori & Del Mar 2014). Treatment plan decisions made without the involvement of patients and families result in patients feeling excluded (Kon, Davidson, Morrison, Danis & White, 2016).
My Experience in Involving Patient Preference and Values in Treatment Plan
In my experience, a 56-year-old patient with end-stage chronic liver disease with failing kidney transplant. The treatment team offered the option of hemodialysis to the patient. He was heartbroken about going back to dialysis after some years with functioning transplanted kidneys. This patient did not want to lose the luxury of staying in his home and wanted a home treatment plan. The patient core values were to stay out of hospital and healthcare facilities and be able to go to work and live his everyday life as much as possible with quality family time. A family meeting was called whereby the treatment team, nurses, nurse manager, patient, and families were present to discuss the treatment plan and choices.
The Value of the Ottawa Hospital Research Institute’s Patient Decision Aid
According to Finderup, Lomborg, Jensen, and Stacey (2020), with the use of patient decision aid, patients are more knowledgeable, clearer about their values, more involved in decision-making, and more likely to make values-based decisions. With his preference and values in consideration, work, school & travel options of daily home hemodialysis, peritoneal dialysis with a cycler at night, nocturnal home hemodialysis as well as standard in-center hemodialysis with before and after work scheduled options were offered per the Ottawa Hospital Research Institute’s Decision Aids Inventory. The patient decision aid is the “My Life, My Dialysis Choice” (The Ottawa Hospital Research Institute, 2019). With the decision, aid, education, and evidence-based information were given to the patient based on his and his family’s values and preference. That helped the patient and family make an appropriate peritoneal dialysis choice with a cycler at night. The vital information on how to prevent infection, when to call the physicians, and limits on weight lifting were provided to the patient and family. The patient and family were satisfied and felt a sense of involvement in deciding on their treatment plan.
The Ottawa Hospital Research Institute’s Decision Aids is significant because it has a lot of information and guidelines for making decisions based on an individual’s preferences and values. This decision aid provides information and covers mostly all the health issues and topics. I would use this aid in my professional career and personal life when making my personal and patients’ health decisions and choices.
In some cases where the patient wants to exercise authority in the treatment decision, clinicians should understand their values and ensure the decision is congruent with those values (Kon, Davidson, Morrison, Danis & White, 2016). Providing appropriate education and incorporating patients’ preferences will encourage compliance with treatment. According to Schroy, Mylvaganam, and Davidson (2014), it is fundamental to engage patients in decision-making, especially with preference-sensitive treatment choices. This will enhance partnership with patients and health providers to exchange vital information. The decision aid helps clear clinicians from the problem of not engaging patients in their treatment plan, improves satisfaction, and facilitates shared-decision making (Finderup, Lomborg, Jensen, & Stacey, 2020).
Finderup, J., Lomborg, K., Jensen, J. D., & Stacey, D. (2020). Choice of dialysis modality: patients’ experiences and quality of decision after shared decision-making. BMC nephrology, 21(1), 330. https://doi.org/10.1186/s12882-020-01956-w
Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.
Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.x
The Ottawa Hospital Research Institute. (2019). Patient decision aids. https://decisionaid.ohri.ca/
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