Discussion: Discussion: 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, 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.

By Day 3 of Week 11

Post 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.

By Day 6 of Week 11

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. 

student one:

Working for a spine surgical center has provided many situations to experience patients being involved in their treatment plan for spinal stenosis. The surgeons for the spine center are focused on alternative medicine and use surgery as a last resort to treat spinal stenosis. Many of the patients have similar responses to their treatment plan and hold a feeling of control throughout the process. The surgeons are very upfront about why they perform the various tests, review the results directly with the patient, and clearly describe the many treatment options available. Unless it is a clear urgent situation, the surgeons always guide patients towards the least invasive option first so they do not feel surgery is their only choice. By doing this, and listening to the patients if they want to try alternatives first, the patients feel involved in their treatment plan and not forced into surgery until they feel confident it is the only option left.

Caring for patients from the start to finish of their surgical journey provides ample opportunity to evaluate how they feel throughout their experience. Most patients begin explaining their experience before surgery was considered an option, and the positive attitudes and comments are overwhelming when the patient feels in control. Being included from the very beginning of the treatment plan allows the patient to hold a sense of pride in their healthcare decisions and leads to better outcomes because they are actively participating in their care. As stated above, unless a patient has a clear urgent case with no alternatives, patients feel involved, in control, and more confident in their care choices leading to more positive outcomes.

The patient decision aid on spinal stenosis is an effective tool to help guide patients towards creating a treatment plan fitting their own comfort level. This decision aid provides excellent information on what spinal stenosis is, what the symptoms are and what they mean, and the treatment options available (Healthwise, 2021). Providing patients with this information allows them to make their own decisions for their treatment plan and take responsibility for their own health. After reviewing the aid, a patient may decide their symptoms are not bad enough for surgery and they want to try alternative options; however, they will also see if the symptoms get worse there is a natural order their plan will follow and the treatments become more aggressive.

Ultimately it is the choice of the patient determining the treatment plan. Patients hold the right to refuse treatment, and can form their own plan of care. Moving forward as a practitioner it will be invaluable to have tools such as the patient decision aids to assist with guiding patients towards their best options for care. Combining the patient’s beliefs and personality with different treatment plans is crucial for success. Not every patient will fit every treatment plan, so getting to know patients and understanding their decision-making process will be beneficial.

References

Healthwise. (2021, July 1). Lumbar Spinal Stenosis: Should I Have Surgery? Retrieved August 6, 2021, from https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=aa121240

Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA, 312(13), 1295. Retrieved August 5, 2021, from https://doi.org/10.1001/jama.2014.10186

Opperman, C., Liebig, D., Bowling, J., Johnson, C., & Harper, M. (2016). Measuring return on investment for professional development activities:. Journal for Nurses in Professional Development, 32(4), 176–184. Retrieved August 5, 2021, from https://doi.org/10.1097/nnd.0000000000000274

The Ottawa Hospital. (n.d.). Patient Decision Aids. The Ottawa Hospital Research Institute. Retrieved August 5, 2021, from https://decisionaid.ohri.ca/

student two:

Nobody knows us better than ourselves. Patients are the most familiar with their own health conditions. They are the best positioned to provide a fundamental understanding of their own experiences, and they define their treatment preferences on the benefits of their treatment outcome. According to Melnyk & Fineout-Overholt (2018), incorporating patients’ preferences and values is essential in evidence-based decision-making. To have a continuous flow of treatment plans and better outcomes, clinicians should listen to the patients and their families about their wishes. One good example is a religious belief. I have encountered so many patients who didn’t wish to receive blood or any blood products because of religion. As clinicians, we have to respect their beliefs and values. In this case, if patients’ hemoglobin were critically low and blood transfusion is not an option. Internists will consult other specialists such as nephrologists and GI to find an alternative method. Hoffman et al. (2014) noted that for patients who have to implement the decision and live with the consequences, this is through this process that patients incorporate the evidence and the expertise of the doctors along with their values and preferences into their decision making. It has always been challenging to manage the patient’s treatment plan.

Patient decision aids are tools that support patients in decision-making by giving them options and possible outcomes in line with their personal values (The Ottawa Hospital Research Institute (2019). In my workplace, it is not unusual that cardiologists would switch cardiac medications depending on the patient’s condition. When this happens, I usually will give patient education regarding the new medication, and I would print out the new medication and give it to the patient. I would ask them to read it carefully, especially the side effects, and if they feel like they have some clarifications and if they are still skeptical, I would ask the prescribing doctor to talk to the patient. The patient decision aid that I have chosen is highly valuable and might lead to an effective decision, it will not just give the facts about the medication, for example, anticoagulation, but it will tell the patient the risks and benefits of taking it to compare to not taking it. And it will also ask the patient about their personal feelings that matter most in their decision. The patient decision aid is definitely useful in my practice. As I already have mentioned, giving patients education about a new medication or procedure is very common in my clinical practice; patient decision aid is a valuable tool that would provide a whole new perspective not just for the patient but also for nurses.

References

Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision-making. JAMA, 312(13), 1295. https://doi.org/10.1001/jama.2014.10186

Melnyk, 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)

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/