Patient Involvement, Social Determinants of Health, and Decision Aids Study Notes
1. Introduction
Patient-centered care: A healthcare approach that respects and responds to patient preferences, needs, and values.
Decision-making in healthcare: Involves collaboration between patients and providers to select treatment options that align with medical evidence and patient priorities.
Decision aids: Tools designed to help patients understand options, weigh benefits/risks, and make informed choices.
Social determinants of health (SDOH): Conditions in which people are born, grow, live, work, and age that influence health outcomes.
2. Importance of Patient Involvement in Treatment Decisions
Ethical foundation: Respect for autonomy.
Clinical benefits:
Improved adherence to treatment.
Better health outcomes.
Reduced decisional conflict.
Psychological benefits:
Increased satisfaction.
Reduced anxiety.
Greater trust in providers.
3. Barriers to Patient Involvement
Provider-related: Time constraints, paternalistic attitudes.
Patient-related: Limited health literacy, cultural beliefs, fear of authority.
System-related: Lack of resources, fragmented care, inadequate access to decision aids.
4. Social Determinants of Health (SDOH)
Economic Stability: Income, employment, financial security.
Education Access and Quality: Health literacy, ability to understand treatment options.
Healthcare Access and Quality: Insurance coverage, availability of providers.
Neighborhood and Built Environment: Safety, transportation, housing.
Social and Community Context: Support networks, cultural norms, discrimination.
Table: Examples of SDOH Impact on Treatment Decisions
Determinant Example Impact
Economic Stability Patient declines costly medication despite efficacy
Education Low literacy limits understanding of risks/benefits
Healthcare Access Lack of insurance prevents follow-up care
Neighborhood Unsafe area limits ability to attend appointments
Social Context Cultural beliefs influence acceptance of treatment
5. Ottawa Hospital Research Institute Decision Aids
Purpose: Provide structured information to support shared decision-making.
Types:
General decision aids.
Specific condition decision aids (e.g., diabetes, cancer, cardiovascular disease).
Features:
Evidence-based summaries.
Clear presentation of options.
Values clarification exercises.
6. Hypothetical Scenario (HIPAA-Compliant)
Situation: A middle-aged patient with early-stage breast cancer was presented with two options: lumpectomy with radiation or mastectomy.
Observation: The patient was initially not included in the decision-making process; the physician leaned toward mastectomy for clinical certainty.
Impact:
Patient felt anxious and disempowered.
Later, when preferences were considered, she chose lumpectomy with radiation, aligning with her values (body image, recovery time).
SDOH Considerations:
Economic stability: Concern about missing work during recovery.
Healthcare access: Availability of radiation therapy nearby.
Social context: Family support influenced decision.
7. Impact of Incorporating Patient Preferences and SDOH
Positive Outcomes:
Improved adherence to treatment.
Enhanced satisfaction.
Reduced decisional regret.
Trajectory Change:
Without patient input: Risk of non-adherence, dissatisfaction.
With patient input: Treatment aligned with values, better psychosocial outcomes.
8. Value of Decision Aid Selected
Decision Aid: Ottawa Hospital’s Breast Cancer Surgery Decision Aid.
Benefits:
Provides clear comparison of lumpectomy vs. mastectomy.
Includes survival rates, recurrence risks, side effects.
Offers values clarification exercises.
Contribution to Effective Decision-Making:
Reduces decisional conflict.
Improves patient knowledge.
Encourages shared decision-making.
9. Application in Professional Practice
Clinical Use:
Integrate decision aids into patient consultations.
Use values clarification to guide discussions.
Educational Use:
Train staff in shared decision-making.
Personal Use:
Apply decision aids when facing personal/family health choices.
10. Reflection and Lessons Learned
Key Lesson: Patient involvement is essential for ethical, effective, and sustainable healthcare.
Decision aids: Bridge the gap between medical evidence and patient values.
SDOH: Must be systematically considered to ensure equitable care.
15‑Question Quiz
Multiple Choice (Select One Answer)
Patient-centered care emphasizes:
A) Provider authority
B) Patient preferences and values
C) Cost reduction only
D) Technology use only
Answer: B
Which ethical principle supports patient involvement?
A) Beneficence
B) Autonomy
C) Justice
D) Non-maleficence
Answer: B
A barrier to patient involvement is:
A) Shared decision-making
B) Limited health literacy
C) Family support
D) Decision aids
Answer: B
Social determinants of health include:
A) Genetics
B) Economic stability
C) Weather
D) Personality traits
Answer: B
Which determinant affects ability to afford medication?
A) Education
B) Economic stability
C) Neighborhood safety
D) Social context
Answer: B
Ottawa Hospital’s Decision Aid Inventory provides:
A) Legal advice
B) Evidence-based decision tools
C) Insurance coverage
D) Genetic testing
Answer: B
Decision aids help patients by:
A) Reducing decisional conflict
B) Limiting choices
C) Avoiding preferences
D) Ignoring values
Answer: A
In the scenario, the patient’s preference was:
A) Mastectomy
B) Lumpectomy with radiation
C) No treatment
D) Chemotherapy only
Answer: B
Not including patient preferences can lead to:
A) Improved adherence
B) Decisional regret
C) Enhanced satisfaction
D) Empowerment
Answer: B
Values clarification exercises are part of:
A) Decision aids
B) Insurance plans
C) Lab tests
D) Billing systems
Answer: A
Healthcare access as a determinant includes:
A) Insurance coverage
B) Family support
C) Cultural beliefs
D) Employment status
Answer: A
Which determinant influenced the patient’s choice in the scenario?
A) Weather
B) Family support
C) Genetics
D) None
Answer: B
Decision aids contribute to:
A) Shared decision-making
B) Provider dominance
C) Reduced patient knowledge
D) Ignoring evidence
Answer: A
Nurse leaders can use decision aids to:
A) Train staff in shared decision-making
B) Limit patient involvement
C) Reduce treatment options
D) Avoid patient education
Answer: A
The ultimate goal of incorporating SDOH and preferences is:
A) Equitable, patient-centered care
B) Provider convenience
C) Reduced patient autonomy
D) Increased decisional conflict
Answer: A
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