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.
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.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/.Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.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.BELOW IS THE QUESTIONPost a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences 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.Learning ResourcesRequired ReadingsMelnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.Chapter 7, “Patient Concerns, Choices and Clinical Judgement in Evidence-Based Practice” (pp. 219-232)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.2014.10186Kon, 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.0000000000001396Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. Journal for Nurses in Professional Development, 32(4), 176-184. doi:10.1097/NND.0000000000000483Schroy, 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.xThe Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/.PLEASE DONT FORGET TO USE THE 7TH EDITION APA FORMAT AND ADD 4 REFERENCES NOT MORE THAN 5 YEARS OLD:Please make sure you go through the rubic. CORE SKILL: patient-centered care is measurable and evidence-linked, not a sentiment. Treat it as a construct with components.
THE DEFINITION TO USE: the Institute of Medicine’s (Crossing the Quality Chasm) — care that is “respectful of and responsive to individual patient preferences, needs, and values,” ensuring patient values guide all clinical decisions. IOM named patient-centeredness one of its SIX AIMS (safe, effective, patient-centered, timely, efficient, equitable). Anchoring in that framework immediately raises the level of the post.
THE COMPONENTS (Picker Institute dimensions): respect for values/preferences; coordination and integration of care; information and education; physical comfort; emotional support; involvement of family and friends; continuity and transition; access.
THE CONCEPTUAL DISTINCTIONS worth drawing, because they are where the real thinking lives:
— SHARED DECISION-MAKING is not the same as INFORMED CONSENT. Consent is a threshold (disclose, ensure capacity, obtain agreement). SDM is a PROCESS of deliberation in which clinician expertise about options meets patient expertise about their own values. Use DECISION AIDS; know that SDM matters most for PREFERENCE-SENSITIVE decisions where the evidence does not dictate one right answer (e.g., PSA screening, treatment for stable angina).
— PATIENT-CENTERED is not the same as PATIENT-DIRECTED. Giving a patient whatever they ask for (antibiotics for a viral URI, opioids on demand) is not patient-centeredness — it is abdication. True patient-centeredness includes honest counsel. Making this distinction explicitly is the mark of a sophisticated post.
COMMUNICATION SKILLS TO NAME: open-ended questions; not interrupting (studies find clinicians interrupt within seconds); MOTIVATIONAL INTERVIEWING (OARS — open questions, affirmations, reflective listening, summarizing; rolling with resistance; eliciting change talk); TEACH-BACK for comprehension; addressing HEALTH LITERACY (nearly half of US adults have limited health literacy; use plain language by default, not as an accommodation).
THE EVIDENCE LINK — this is what makes the post more than an assertion: patient-centered communication is associated with better adherence, improved chronic disease control, higher satisfaction, and reduced malpractice claims (the malpractice literature is striking — communication failure, not clinical error, predicts who gets sued). Cite it.
BARRIERS: time pressure and productivity metrics, EHR screen-gaze reducing eye contact, language barriers, implicit bias, and power asymmetry.
CONNECT TO: the Quadruple Aim (patient experience is one of the four), HCAHPS as a measurement instrument (and its limitations as a proxy), and cultural humility.
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