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.
- 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.
Expert Answer and Explanation
Providing patient-centered care involves being sensitive, responsive, and respectful to an individual’s preference when making clinical decisions (Kuipers et al., 2019). According to Hoffmann et al. (2014), patient-centered care is founded on the premise of evidence-based practice and shared decision-making. I once encountered an elderly patient who had undergone a proctectomy. In the process of recovery, he was weighing his options on whether to subscribe to one of the assisted living facilities. While his children were opposed to the idea, I decided to engage them in a constructive conversation, where they were able to evaluate the available options, factoring in their schedules, and the needs of their father. However, what changed their minds was the input of their father that convinced them why it was the right option at that moment. They decided to temporarily place their parent in the facility for a three-month period where he was properly cared for until he properly recovered and was later taken in by one of his sons. In the situation, it was important to consider patient autonomy in decision-making, rather than imposing a decision that may not have the patient’s best interest at heart.
Patient decision aids are facilitative tools that help patients in making informed decisions that impact their health outcomes. These tools help patients by providing options and possible outcomes factoring in the patient’s values (The Ottawa Hospital Research Institute, 2019), The decision aid tool that I selected is the nursing home tool titled “Nursing Homes
During the COVID-19 pandemic, should I or my family member go to live with family or stay in the long-term care or nursing home?” This tool is applicable to at-risk COVID-19 elderly patients, who are considering whether to live with their family or stay in a long-term care facility or nursing home. With this tool, the patient can come up with an informed decision to the hard question of where it is safe to live considering the risks attached with COVID-19 towards the elderly, while at the same time receiving the quality and preference in terms of care. Working in a long-term care facility, I can use the tool to facilitate shared decision-making with patients who are unsure of where they want to live.
Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision-making. Jama, 312(13), 1295-1296. doi:10.1001/jama.2014.10186
Kuipers, S. J., Cramm, J. M., & Nieboer, A. P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC health services research, 19(1), 13. https://doi.org/10.1186/s12913-018-3818-y
The Ottawa Hospital Research Institute. (2019). Patient decision aids. https://decisionaid.ohri.ca/
Patient involvement in the process of working together with patients, caregivers, and loved ones shapes, influences, or guides treatments as they develop. My healthcare organization is a nursing home with rehab, dementia, and long-term care units. In the rehab unit, we had a patient that constantly returned to the facility after being discharged from rehab. The patient had COPD and diabetes with DVT ulcers present in his left leg. This patient did not comply fully with his medication regimen and constantly smoked, exacerbating his condition. Patient education was given by several nursing staff, but there was no effective management of adequate changes being made. There was a lack of patient involvement due to nurses’ lack of resources to impact patients’ involvement.
Evidence tells us that supporting patients to be actively involved in their care, treatment, and support can improve outcomes and experience for patients and potentially yield savings for the system through more personalized commissioning and supporting people to stay well and manage their conditions. It was crucial to involve the patient in setting up a care plan by educating them on evidence-based practice. Successfully reducing readmissions and improving patient satisfaction requires hospitals to engage patients in their care (Krist et al., 2017). Getting the patient involved in decision-making on their plan of care enabled the patient to have control of the care delivered and thus led to improved patient outcomes (Gilissen et al., 2018).
The decision aid employed to help this patient quit smoking was Quitting Smoking: Should I Use Medicine? Using medicines and nicotine replacement products (patches, gum, lozenges, and inhalers) can double the patient’s chances of quitting smoking. Getting counseling and using the medicine can increase the patient’s quitting even more. If patients smoke fewer than ten cigarettes a day, they may not need medicines to help them quit smoking. It is rare for someone to get addicted to nicotine medicines because the nicotine is released slowly at low levels into your bloodstream.
Nicotine replacement products may cause some side effects, such as problems with sleep or red and itchy skin with the patch. Medicines in pill form can cause nausea, dry mouth, and trouble sleeping. The side effects are not bad enough for most people to stop using the medicines. Nicotine medicines have less than half of the nicotine than cigarettes. Moreover, by itself, nicotine is not nearly as harmful as smoking. The tars, carbon monoxide, and other toxic chemicals in tobacco cause harmful effects. Many insurance companies will pay for all or part of the cost of medicines used to quit smoking (The Ottawa Hospital, 2020).
When nursing and counseling staff started using more evidence-based research publications and adapted to the learner style of the patient, he started to become more engaged in his plan of care. This patient used nicotine replacement products such as patches which, along with counseling, decreased his number of readmissions in the long term. There are simple ways hospitals can engage patients in their care, such as educating patients through verbal and written communication, encouraging patients to ask questions, and encouraging feedback (Melnyk, & Fineout-Overholt, 2019).
Considering the patient preferences and decisions played a vital role in the treatment process. It is important to educate patients to promote confidence and make informed decisions (Reid et al., 2018). Finding evidence of the benefits of smoking cessation and educating patients on the evidence greatly impacted the patient’s commitment to the plan of care. Evidence-based practice must be in conjunction with shared decision-making to improve patients’ outcomes (Hoffman et al., 2014).
The Ottawa Personal/ Family Decision Guides are very useful in my professional practice when involving patients to make decisions in their health care. Patient decision aids help patients become involved in decision-making by providing information about the options and outcomes and clarifying personal values (The Ottawa Hospital, 2020). The decision aid inventory enables the user to make informed treatments and provides information about the clinical diagnosis. Patient involvement is crucial for identifying the questions to ask and the outcomes to assess; therefore, it is increasingly common to involve patients or patient advocacy groups in study design (Reid et al., 2018). Incorporating patient preferences and values impacted the outcome. Education and nicotine replacement medicine incorporating patient preferences allow the patient to become more involved in his treatment. The decision aid contributed to patient education and gave nursing staff more options.
Gilissen, J., Pivodic, L., Gastmans, C., Vander Stichele, R., Deliens, L., Breuer, E., & Van den Block, L. (2018). Achieving the desired outcomes of advance care planning in nursing homes: a theory of change. BMC geriatrics, 18(1), 1-14. https://doi.org/10.1186/s12877-018-0723-5
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. https://doi: 10.1001/jama.2014.10186
Krist, A. H., Tong, S. T., Aycock, R. A., & Longo, D. R. (2017). Engaging patients in decision-making and behavior change to promote prevention. Information Services & Use, 37(2), 105-122. https://doi: 10.3233/ISU-170826
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed). Philadelphia, PA: Wolters Kluwer. The Ottawa Hospital. February 25, 2020. Patient Decision Aids. https://decisionaid.ohri.ca/index.html
Reid, R., Escott, P., & Isobel, S. (2018). Collaboration as a process and an outcome: Consumer experiences of collaborating with nurses in care planning in an acute inpatient mental health unit. International Journal of Mental Health Nursing, 27(4), 1204-1211. https://doi.org/10.1111/inm.12463