Patient Preferences and Decision Making Discussion
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, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
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/Links to an external site..
Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.
After you have chosen a topic (or condition) and a decision aid, consider if social determinants of healthLinks to an external site. were considered in the treatment plan Social determinants of health can affect a patient’s decision as these are conditions in the patient’s environment, such as economic stability, education access, health care access and quality, neighborhood, and social and community context.
NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.
BY DAY 3 OF WEEK 11
Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences, social determinants of healthLinks to an external site., and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences, social determinants of health, and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.
(Please Note: The underlined “social determinants of health” in the above content is meant to hotlink to the following Walden webpage and content:
Social Determinants of Health – Social Determinants of Health – Academic Guides at Walden Links to an external site.University)
Respond to at least two of your colleagues on two different days 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.
Ilsa Waterman
Situation and shared decision-makingI recently had a conversation with a pregnant patient about circumcision. She was expecting a boy, and she and her husband were uncertain if they would choose to have the infant undergo the procedure. The mother was Hispanic, and, in her culture, penises are usually left natural, whereas her husband was white and circumcised himself. As I provided them with an overview of the procedure, timing, recovery, benefits, and risks, I also recognized that many patient preferences, values, and social determinants of health are in play. There was no right or wrong answer, only the best for this couple and their unborn child. While circumcision was not a life-threatening or complex decision, the collaborative process consisted of determining treatment goals, sharing information, and deliberating to reach a shared decision. This shared decision-making ensured that the parents’ preferences would be honored (Kon et al., 2016).Patient preferences and valuesPatient preferences and values about circumcision may be driven by religion, culture, concern for the social norm, benefits of the procedure, and risks of surgery. Circumcision is an important religious standard in many Jewish and Muslim cultures. The decision may also be influenced by family traditions, hygiene perceptions, medical necessity, or preventive health care (Mayo Clinic, n.d.). While the American Academy of Pediatrics task force on circumcision advises that the health benefits of the procedure outweigh the risks, the authors do note that parents must do what they feel is in the best interest of their child (Blank et al., 2012)Social determinants of healthAs the social determinants of health (SDOH) are nonmedical factors that influence health outcomes, they play an essential role in decision-making. All domains of the SDOH are pertinent to the decision to circumcise. Economic stability may impact a patient’s or family’s ability to afford an unneeded surgery instead of having to prioritize food or housing. Similarly, health care access plays a role in decision-making, whether it is an inability to afford health care or not having a trusted or convenient facility to seek care. Access to education and having the pertinent data and educators to make an informed decision can influence decision-making, as can social and community context. Certain cultures accept and promote circumcision as a social norm, while others do not prioritize it (CDC, 2022). Value of the patient decision aid and its future useThe decision aid succinctly addressed all facts about circumcision, including the definition, timeline, risks, and benefits. It laid out the two primary options and factored in patient/family-specific values regarding the procedure. It then provided a quiz to ensure understanding of the facts and a summary of the information entered, which led to the decision. The record of answers showed which way you’re leaning and how confident you feel about your decision.I have already bookmarked the personal decision tool on my work computer. The device is an excellent prompt to ensure patients have all the factual pro and con information needed and allows them to consider personal considerations. I like that the website empowers the patient by saying, “Your personal feelings are just as important as the medical facts” (The Ottawa Hospital Research Institute, n.d.). As I perused the various topics, I was interested in the topic of Healthy Aging: Is It Time to Stop Driving? As a future gerontology nurse practitioner, I can see using the tool to guide difficult conversations with patients and their families, respecting their input, and providing data to reach the best, shared decision.ReferencesBlank, S., Brady, M., Buerk, E., Carlo, W., Diekema, D., Freedman, A., Maxwell, L., & Wegner, S. (2012). Male Circumcision. PEDIATRICS, 130(3), e756–e785. https://doi.org/10.1542/peds.2012-1990CDC. (2022). Social Determinants of Health. Centers for Disease Control and Prevention. https://www.cdc.gov/about/sdoh/index.htmlLinks to an external site.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 statementLinks to an external site.. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396Mayo Clinic. (n.d.). Circumcision (male) – Mayo Clinic. Www.mayoclinic.org. Retrieved August 2, 2023, from https://www.mayoclinic.org/tests-procedures/circum… Ottawa Hospital Research Institute. (n.d.). A to Z Summary Results – Patient Decision Aids – Ottawa Hospital Research Institute. Decisionaid.ohri.ca. Retrieved August 1, 2023, from https://decisionaid.ohri.ca/Azsumm.php?ID=1035 ReplyReply to Comment
Patience Nnochin Ebi
Initial PostUnderstanding preferences strengthen our ability to tailor evidence-based interventions for our patients. Helping patients acknowledge and share their unique preferences is essential for patient-centered care. Patients’ participation in their medical decision-making has been associated with improved patient satisfaction and health outcome (Vahdatet et al., 2014). According to Melnyk and Fineout-Overholt (2018), patient-centeredness is a key component to incorporating patient preferences into practice and values decision-making supported by evidence-based research. Healthcare providers involve their patients in every aspect of the decision-making of their care and the involvement should be respected and sympathetic to each patient’s preferences, needs, and values (Melnyk & Fineout-Overholt, 2018). Patient involvement in the decision-making process of their care results in improved treatment outcomes and activities of daily living (Vahdatet et al., 2014). How Incorporating Patient Preferences and Values Impacted the Outcome of Treatment PlanI recall a time when I experienced incorporating patient preferences and values that influenced the outcome of their treatment plan. A 56-year male was admitted into our Psychiatric unit, though he has a mental problem, but also had a medical diagnosis of advanced kidney disease (kidney failure). Since it is not always possible to carry out a kidney transplant straight away, Hemodialysis was prescribed until a suitable donor kidney becomes available. He undergoes a Hemodialysis procedure, which is usually carried out three (3) days a week, with each session lasting around 4 hours. The patient would be taken to the Hemodialysis Center within the hospital where he would be dialyzed as per order. As we all know, waste products and fluid can build up to dangerous levels in the body if untreated, this can cause a few unpleasant symptoms and eventually be fatal. I observed severally that this patient has been noncompliant with his treatment regimen. Sometimes, he would refuse to be taken to the procedure. One day, two of his family members were visiting him, and I utilized the opportunity to talk to him before his family about the consequences of refusing to be dialyzed. I explained to him that missing dialysis treatment could place him at risk for building up high potassium, which can lead to heart problems such as arrhythmia, heart attack, and death. In addition, high phosphorus can weaken his bones over time and increase his risk for heart disease. His family and I reassured him that if he agreed to go to dialysis as ordered, it would aid in prolonging his life by filtering the waste products and water from his blood. He asked questions regarding the pros and cons of the procedure. I provided him with educational pamphlets relating to dialysis and assured him that the healthcare providers would respect whatever decision he would like to make. After weighing both pros and cons, he decided that he wanted to get the procedure done and expressed his gratitude for providing the support and educational needs to help him make the final decision concerning his procedure. How Including Patient Preferences and Values might Impact the Trajectory of the Situation and how these were Reflected in the Treatment Plan.Patients have a right to autonomy in decision-making and healthcare providers should honor that right even when patients do not make the best treatment decisions according to healthcare practice (Kilbride & Joffe, 2018). Sometimes after involving some patients in discussing their options, they still insist on their preferences. The physicians have no option but to go along with their options. Along with clinical guidelines, patient preferences provide direction for selecting treatment options and tailoring interventions. Patient preferences also help inform choice in clinical decisions where science has yet to provide dominant solutions to health care problems. Including patients’ preferences and values may change in a way the medical providers do not expect. Sometimes it results in a surprising outcome, but often, it is what the physician said it would be. As healthcare providers, we must respect the patient’s wants and needs, and that means going in another direction because that is what the patients want, then that is what we are going to do (Davoodvand, et al 2016). The physicians do get upset sometimes, as nurses, we must advocate and speak up for our patients. If nurses, physicians, and other professionals know more about patients’ health-related preferences, care would be more effective, and closer to the individuals’ desires.Describe how you might use this decision-aid inventory in your professional practice or personal life. Using patient decision aid is crucial in forming best practices because patients can compare options and make informed decisions. The decision aid website presents a brief discussion and comparison of different options including the benefits and risks of each option (The Ottawa Hospital Research Institute, 2019). The website is important in enabling patients to make decisions based on credible information. Practitioners can use this website to inform their practice and decision-making. Patient involvement in treatment enhances care outcomes and keeping patients informed ensures that the best-practice strategies are implemented. I will recommend Ottawa to my patients. Personally, this inventory aid will help me understand what my choices are when discussing with my physician.ConclusionThe impact of involving patients in treatment is often positive with increased patient knowledge and health maintenance. Evidence shows that patient satisfaction can be improved with their involvement in care (McAlpine et al., 2018). Patients cannot have a preference if they do not have or are not given a choice, and patients cannot have a choice if they are not truly informed of all options. Valuing patient preferences is grounded in the commitment to fully inform the patient of available options (including the evidence supporting options), ensuring the patient has a meaningful understanding of options, actively engaging the patient in conversations where preferences are elicited and explored, and incorporating those preferences within a patient-centric plan of care ((Kilbride & Joffe, 2018). We must incorporate our clinical expertise and patient preferences and values to include the art with the science to see patient outcomes improve.ReferencesDavoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses’ viewpoint: a qualitative study. J med Ethics Hist Med. Retrieved August 3, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958925/Links to an external site..Kilbride, M. K., & Joffe, S. (2018). The new age of patient autonomy: Implications for the patient-physician relationship. Juma, 320(19), 1973-1974, https://doi.org/10.1001/jama.2018.14382Links to an external site.McAlpine, K., Lewis, K. B., Trevena, L. J., & Stacey, D. (2018). What is the effectiveness of patient aids for cancer-related decisions? A systematic review sub-analysis. JCO Clinical Cancer Informatics, 2, 1-13. https://doi.org/10.1200/CCI.17.00148Links to an external site.Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidenced-based practice in nursing and healthcare: A guide to best practice. Wolters KluwerThe Ottawa Hospital Research Institute 92019). Patient decision aids. Retrieved August 3, 2023, from https://decisionaid.ohri.ca/
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