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.
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Module 6 Initial Discussion Post
BRCA 1 and BRCA 2 are both gene mutations that increases the risk of breast and ovarian cancer among the younger generation along with other types of cancer (Collins & Isaacs, 2020). They are often faced with decision making that can be tough to decrease their risk of these cancers (Kautz-Freimuth et al., 2021). For this discussion, I am going to use myself as an example for the patient. I was diagnosed with BRCA 2 gene when I was 25 years old, I had been waiting to test for it until after I had kids because I knew I wouldn’t want to do any intervention until after. Of course, when the positive result came, I got a whole new team of doctors to review all the aspects of this gene.
I was highly involved in the decision making and had all the preferences included that were important to me. My decisions were to keep screening every 6 months or to go through with a double mastectomy and hysterectomy to decrease my chances. With my family history I underwent the surgical aspect of it instead of screening as I felt screening wouldn’t prevent it but just try to catch it early. I knew there was a chance that I would not get cancer, but there was a higher chance that I would so I had my mind made up. I had many different options and preferences that were taken into consideration when deciding what type of hysterectomy I wanted, what type of mastectomy I wanted and implant placed, when I wanted these surgeries completed and I felt that I was really in control of my healthcare at this point and all my physicians were very supportive of my decisions.
When I looked at the references provided, I looked at breast cancer screening since this fits into the topic I am discussion. The decision aid that they were utilizing is called DynaMed Decisions. DynaMed Decisions is a clinical tool that provides evidence based information and tools, that help patients make decisions that are patient centered and personalized to them (EBSCO, 2023). There are two different areas that you can utilize, one area is clinical decision smart tools that provides the EBP tools and information and helps guide patients on making informed decisions. The second area is shared decision making tools, this area has questions that are frequently asked by patients and the answers, and helping them engage in the right tools needed to make decisions (EBSCO, 2023). I feel this would be effective for patients as it can provide them with the right information needed to make informed decisions, it is updated daily with any new information or EBP, it provides information that is most common as some people do not know where to start or what to ask. Personally, I do feel this would have been beneficial to myself when making these decisions. I used google a lot when trying to find the right answers and of course a lot differ. Having an area that you can go and its readily available with all the information and insight that you need would of made my decision a lot easier, if I was back in that time I would absolutely utilize it.
References:
Collins, J., & Isaacs, C. (2020). Management of breast cancer risk in BRCA1/2 mutation carriers who are
unaffected with cancer. The Breast Journal. https://doi.org/10.1111/tbj.13970Links to an external site.
EBSCO. (2023). Get to Know DynaMed Decisions. https://www.ebsco.com/clinical-decisions/dynamed-Links to an external site.
solutions/dynamed-decisions
Kautz-Freimuth, S., Redaèlli, M., & Rhiem, K. (2021). Development of decision aids for female BRCA1 and
BRCA2 mutation carriers in Germany to support preference-sensitive decision-making. BMC
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Collapse SubdiscussionNtumba Kabongo Response #1
Hi Leslie, I commend you for being part of such a big and noble cause for you and your family. Having been an oncology nurse for many years, I can see how our own experiences can impact the decision that we make for ourselves in our private lives and how those decisions can impact our behavior towards our patients.
Patients have the right to know and be involved in their decision making for their care. In my case, I have seen the positive and the negative aspects of involving patients in the decision making for their care and at times very complex. Incorporating patient preferences and values into the specific situation helps the care provider develop. An individualized intervention measure for the a specific condition (Melnyk & Fineout-Overholt, 2018). One of the decisions support solutions is the dynaMed Decision that you talked about. This system supports solutions designed to enhance clinical decision making, thus decreasing the burden on providers (EBSCO, 2023). This system offers evidence-based tools that allows provides to deliver effective patient-centered and personalized care.
References:
EBSCO. (2023). Get to Know DynaMed Decisions. https://www.ebsco.com/clinical-decisions/dynamed-Links to an external site.Links to an external site.
solutions/dynamed-decisions
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
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Collapse SubdiscussionCrystal Lewis Hi, Leslie,
Thanks for sharing your experience. Do you plan to utilize such tools, within your organization? What benefits would you present to your staff?
Excellent post!
Dr. Lewis
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Collapse SubdiscussionMaxine A Lewis Hi Leslie, wow thanks for sharing you experience you arm yourself with the needed information and made the decision you felt was right for you. The DynaMed decision tool dis a great job in equipping you to make the best possible decision for your particular diagnosis. You seem very confident is what you wanted done as well as your preference of when. A great examples of the utilization to patient decision aid which can be used alone or as a part of structured counseling or patient education. Minimal quality standards include an adequate evidence base, completeness, absence of bias, and intelligibility (Lenz et.al, 2012). DynaMed offers solutions such as evidence-based tools that enable providers to deliver effective, patient-centered and personalized care and amazingly the tool was created a team of clinical experts who continuously monitor the site (DynaMed, 2023). The article on Management of breast cancer risk in BRCA1/2 mutation
carriers who are unaffected with cancer is also very informative and I will continue to read. Thanks’ for sharing.References
EBSCO. (2023). Get to Know DynaMed Decisions. https://www.ebsco.com/clinical-decisions/dynamed-Links to an external site.
solutions/dynamed-decisions
Lenz, M., Buhse, S., Kasper, J., Kupfer, R., Richter, T., & Mühlhauser, I. (2012). Decision aids for patients. Deutsches Arzteblatt international, 109(22-23), 401–408. https://doi.org/10.3238/arztebl.2012.0401
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Collapse SubdiscussionJasmine London Hi Leslie,
Thanks for sharing your story. It was great that you felt that you were in control of your health and that you were highly involved in decision making. It definitely makes a difference to the quality of the care that you receive if your preferences and values are taken into account. The DynaMed Decisions is a great tool that was designed to enhance clinical decision making. It helps patients and clinicians navigate decisions by incorporating patient’s preferences in clinical scenarios (EBSCO, 2023). These aids are definitely beneficial to patient care because it allows patients to consider their options and prepares them to participate in making their own health care decisions.
EBSCO. (2023). Get to Know DynaMed Decisions. https://www.ebsco.com/clinical-decisions/dynamed-Links to an external site.
solutions/dynamed-decisions
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Collapse SubdiscussionSulaiman Yassin Jalloh Hi Leslie,
It is interesting to learn about the significance of patient preferences in clinical practice from your experience. We all agree that patient preferences have a substantial impact on the trajectory of the treatment process and treatment outcomes. While clinician relies primarily on evidence-based clinical guidelines in making most clinical decisions, the guidelines should not substitute patient preferences (Zhang et al., 2019). As indicated in your example, the consideration of patient preferences in decision-making gives patients a positive attitude toward the care process. The patients become more inclined to adhere to care procedures when their preferred options are considered. The failure to consider patient preferences may trigger the patient to abandon the treatment (Melnyk & Fineout-Overholt, 2018). For instance, you could have abandoned the surgical procedure if the physicians were not supportive of your decisions. The patient preferences should be combined with clinical guidelines for effective outcomes.
References
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Zhang, Y., Coello, P. A., Guyatt, G. H., Yepes-Nuñez, J. J., Akl, E. A., Hazlewood, G., … & Schünemann, H. J. (2019). GRADE guidelines: 20. Assessing the certainty of evidence in the importance of outcomes or values and preferences—inconsistency, imprecision, and other domains. Journal of Clinical Epidemiology, 111, 83-93. https://doi.org/10.1016/j.jclinepi.2018.05.011
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Collapse SubdiscussionMleh Porter Hello Leslie,
Thank you for sharing your personal experience as a patient. It was great to learn you felt you were involved in the decision-making of your treatment. Patients need to be involved in making decisions related to their care. I have seen that incorporating patient preferences, although challenging in some cases for the treatment team, can lead in many cases to a positive outcome. According to a recent study, the relationship between providers and a patient and shared decision-making are vital factors affecting patients’ compliance with their treatment. Shared decision-making between the healthcare team and the patient positively affects the patient’s compliance with the treatment (Deniz et al., 2021). It has become essential in today’s health care delivery to involve the patient’s preference to provide quality care. Many laws are being implemented to encourage patient-centered care delivery and respect patients’ preferences, needs, and values. Interestingly, patient involvement in decision-making appears to be associated with less intention to complain about health care (Birkeland et al., 2021).
References
Deniz, S., Akbolat, M., Çimen, M., & Ünal, Ö. (2021). The mediating role of shared decision-making in the effect of the patient–physician relationship on compliance with treatment. Journal of Patient Experience, 8, 237437352110180. https://doi.org/10.1177/23743735211018066
Birkeland, S., Bismark, M., Barry, M. J., & Möller, S. (2021). Does greater patient involvement in healthcare decision-making affect malpractice complaints? A large case vignette survey. PLOS ONE, 16(7). https://doi.org/10.1371/journal.pone.0254052
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Collapse SubdiscussionCrystal Lewis Hi, Class,
By Day 3 of Week 11 your initial post is due
By Day 6
Respond to at least two of your colleagues on two different days
Thanks!
Dr. Lewis
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Collapse SubdiscussionUrsla Anyizi-Taku Main Post
Patient Preferences and Decision Making
In the modern and advanced healthcare system, patient preferences and their involvement in decision-making are prioritized in many health facilities. Hospitals have enhanced client involvement because it affects healthcare delivery, patient experience, cost, and quality of care. Healthcare professionals can improve patient communication and reduce barriers to care by understanding patient preferences and including their clients in making decisions. Although involving patients in decision-making is challenging, the issue can be addressed by training healthcare givers because such sessions empower them with skills to engage their clients effectively.
Experience With Patient Involvement in Healthcare Decision
In my clinical practice as a nurse in an intensive care unit, I have had positive and negative experiences with patient involvement in healthcare decisions. Throughout clinical practice, involving clients in the decisions making process has had positive impacts because it reduces nurses’ time on non-clinical work (Kon et al., 2016). An example in my clinical practice focuses on scenarios where patients who had the ability to speak about their symptoms were allowed to say how they were feeling. In such cases, such individuals’ stay at the intensive care unit was shorter than clients in a coma. Notably, allowing individuals to share their insights and involving them in decision-making is beneficial because it makes it easier to make an informed decision on the most appropriate treatment option. Notably, this is because they are more familiar with their symptoms. However, there are a few situations where patient involvement could lead to negative outcomes for a client. For instance, if an individual asks a nurse to reduce their dose because they are feeling better. In this case, involving the patient and doing, as they say, might have detrimental impacts on the client’s health. Overall, patient involvement has positive and negative impacts; however, the positive impacts outweigh the negative ones.
Significance of a Patient Decision Aid in Informing Best Practices for Patient Care and Healthcare Decision Making
The Patient Decision Aid plays a central role in informing best practices because it assists patients in making decisions by guiding them through the maze of pharmaceutical data and research related to their treatment plan. The patient decision aid is essential because it helps a client make informed decisions regarding treatment options and the cost associated with the suggested plan (The Ottawa Hospital Research Institute, 2019). Notably, this information allows clients to choose effective choices regarding their healthcare needs. In addition, the patient decision aid provides an overview of potential benefits and harms so clients can make informed choices based on evidence-based data (Melnyk & Fineout-Overholt, 2018). Moreover, it provides information on available complementary treatments that may improve outcomes for patients who want more extensive or specialized care than what is provided by their primary care physician. Overall, with the patient’s decision aid, many clients can make better decisions about their treatment plan because they understand their medications better and know the risks and benefits of following the physician’s recommendations.
Conclusion
Training helps healthcare providers effectively involve patients in their treatment plans. My clinical experiences made me understand that client involvement has both adverse and positive outcomes. In addition, patient decision aid is crucial because it helps clients understand their medications better and know the risks and benefits of following the physician’s recommendations. Healthcare facilities should adopt patient decision aid because it plays a pivotal role in healthcare delivery.
References
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in ICUs: An American College of critical care medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188-201. https://doi.org/10.1097/CCM.0000000000001396
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
The Ottawa Hospital Research Institute. (2019). Patient decision aids. https://decisionaid.ohri.ca/
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Collapse SubdiscussionCrystal Lewis Excellent post, Ursla!
How does this tool enhance your client’s ability to be more involved in the plan of care?
Dr. Lewis
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Collapse SubdiscussionUrsla Anyizi-Taku First Response
Thanks for your observations,
This should happen at every level where decisions ultimately affect patients’ lives. Therefore, patients have a moral and ethical right to play a meaningful role in developing healthcare policies. Engaging patients in health policy decision-making helps to ensure that policies reflect patient and caregiver needs, preferences, and capabilities, making it an appropriate and cost-effective way to address the needs of the growing number of people with chronic conditions (Deber & al, 1996). The influence of patient involvement and the impact of the patient’s voice on policymaking at my institution has called the attention of all healthcare stakeholders to acknowledge the importance of the involvement of patients and patients’ organizations in all decision-making that will impact patients’ lives (Institute of Medicine, 2001). They have used a variety of engagement methods to reach underrepresented groups and gather a diversity of views. The healthcare organization Reviews existing healthcare mechanisms for patient involvement, considering the company’s guidelines and talking to patients and organizations. This enhances the client’s ability to be more involved in the plan of care.
Reference
Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision-making? Arch Intern Med 1996;156(13):1414-20.
Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century. Washington, DC, National Academy Press; 2001.
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Collapse SubdiscussionCrystal Lewis Hi, Ursla,
Excellent reply!
Dr. Lewis
Edited by Crystal Lewis on Feb 11 at 9:02am
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Collapse SubdiscussionSulaiman Yassin Jalloh Hi Ursla,
Thank you for sharing your post. I agree with you that patient preferences are increasingly prioritized in today’s healthcare system. The case that you have presented demonstrates the influence of the involvement of patient preferences in clinical decisions. In addition to the selection of appropriate treatments, the involvement of patient preferences is beneficial in ensuring patients comply with the treatment (Melnyk & Fineout-Overholt, 2018). Patients would be motivated to take the prescribed medications when they participated in decision-making. However, as noted in your post, there are limits in consideration of patient preferences, especially when there is a high risk of harm (Ackley et al., 2019). Educating the patient about the detrimental effects of their preferences is necessary to avoid treatment noncompliance.
References
Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. (2019). Nursing diagnosis handbook E-book: An evidence-based guide to planning care. Elsevier Health Sciences.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
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Collapse SubdiscussionMleh Porter Hello Ursla,
I enjoyed reading your post and agree that involving patients could either have positive or negative outcomes, especially if the patient is not informed to make good decisions related to their treatment. This makes it vital for the healthcare team to provide the patients with the necessary information needed for patients to be able to make better decisions related to their care. The relationship established between the healthcare team and the patient plays an essential role in the treatment process and the effective delivery of care. The connection is also strengthened through shared decision-making between the patient and the healthcare team (Deniz, 2021). Including patients in their treatment will lead to improved health outcomes and better satisfaction with the care experience and the healthcare team experience (Krist et al., 2017). I agree that there are times when patients make poor decisions. However, when a patient can defend their judgment, they also have a right to make decisions, even if the decision does not align with what the healthcare team believes is beneficial to the patient (Olejarczyk & Young, 2022).
References
Deniz, S., Akbolat, M., Çimen, M., & Ünal, Ö. (2021). The mediating role of shared decision-making in the effect of the patient–physician relationship on compliance with treatment. Journal of Patient Experience, 8, 237437352110180. https://doi.org/10.1177/23743735211018066Links to an external site.
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.org/10.3233/isu-170826
Olejarczyk, J.P., & Young, M. (2022). Patient rights and ethics. Statpearls- NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK538279/
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Collapse SubdiscussionAndrea M Allen Module 6
Patient Preferences and Decision Making
Illness is a biological and social process. Clinicians need to be aware of social and cultural factors that affects the health-care encounter and their impact in decision making. Realizing this, can lead to more efficient and effective healthcare methods.
I work in a Hospital for Mental Health. The hospital provides intermediate care between the acute setting and the patient’s home. The Patients I take care of have various mental health issues. However, one of the most common behaviors I observe with patients in terms of involving them in their care is a pattern of non-compliance. Issues for non-compliance are sometimes linked to patient’s lifestyle, i.e., smoking, sharing, or withholding information such as the fact that they are taking supplements instead, treatment decisions, or alternative therapies that can be (more or less) aggressive in nature according to (Seminoff, 2013).
Take for example Jane Dix, (Not her real name), a young female in her 40’s, who returns to the hospital at least every two years since she was 21years old, with multiple medical problems and has delusional beliefs that nothing is wrong with her, that she was brought to the hospital because “they want to get into her business.” Jane superficially corporates with taking some of her medicines including one that should improve her mental health condition, but only take the lowest dosage. Jane has violent tendencies and occasionally attack staffs. Jane is obviously undermedicated and will refuse all medications whenever the family is informed of discharge planning. The family at one point informed the staffs and doctor that Jane should be able to take a break from the medications at times. As a result, Jane is in the hospital for eight months because efforts to improve her health are sometimes sabotaged by her or her family who prefers to keep her hospitalized at this hospital, due to numerous boarding homes placement failures and the inability to remain home with the family. Such situation causes a burden on the facility and increases its length of stay (LOS). The treatment Plan continues to include “Lack of knowledge, Delusional beliefs, non-compliance, Poor insight & judgment, violence, and placement issues.
Including patient preferences and values could very well cause further deterioration of Jane’s condition in this situation. According to (Weijden, 2010), For professionals to conceive clinical practice guidelines as tools for decision making, patient involvement with regards to preferences and characteristics should be taken into consideration. To change the trajectory of the situation, in another world where mental health was not the issue, it would have been conducive to have both patient and family decide on a treatment plan that works best for the patient preferences and values. There is obvious conflict in every aspect of having Jane or her family make decisions about her care. Numerous attempts to educate Jane and her family about her health and treatment options have fallen on deaf ears.
To assist this Jane for effective decision making, giving the fact that this patient is involuntary committed in the hospital on a temporary basis, I suggested to the Team members that further clinical decision is warranted such as obtaining guardianship for continuous successful treatment. Staffs can then engage patient in a discussion of the pros and cons of treatment and have her relate them to her values and needs as appropriate and participate in shared decision making. Eventually proper placement can be made hopefully, with patients’ characteristics and preference in mind to provide her with a safe environment, and better quality of life.
A person’s perspectives, beliefs, expectations and goals for their health and life is important in any disease process. Information regarding education for one’s physical comfort such as emotional support and alienation of fear and anxiety, family and friends’ involvement can be the catalyst for improving. It is important to provide direction for selecting treatment options and tailoring interventions to meet the patients need.
References
Siminoff L. A. (2013). Incorporating patient and family preferences into evidence-based medicine. BMC medical informatics and decision making, 13 Suppl 3(Suppl 3), S6. https://doi.org/10.1186/1472-6947-13-S3-S6Links to an external site.Links to an external site.
Weijden, T. Le`gare, F. […], and Elwyn, G. (2010). How to integrate individual patient values and preferences in clinical practice guidelines? A research protocol. Implement SCI. 5:10. doi: 10. 1186/1748-5908-5-10
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making Links to an external site.Links to an external site.. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186
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Collapse SubdiscussionBertina Boma Soh Greetings, Andrea; I enjoyed reading your article. It was educational, and I loved your example of Jane Dix, a 40-year-old woman hospitalized at least once every two years since she was 21 years old with several medical problems and delusional beliefs that nothing was wrong with her. Many patients face a considerable problem with non-compliance. In the United States and most European nations, patient-centered care is the most widely acknowledged medical and healthcare approach. In research by Cohen and Sakuraba, a sizeable minority of patients with stage C HF did not adhere to the suggested medication. Infection was the most frequently detected precipitating cause, followed by arrhythmias. The studies found that routine practice must involve an ongoing assessment of HF patients’ adherence to treatment and lifestyle adjustments to educate non-compliant individuals appropriately (Cohen & Sakuraba, 2022).
In the last five to ten years. The patient-centered care paradigm prescribes treatment plans with the patient’s objectives, comprehension, and well-being as the major concern (Chittenden, 2022). Numerous criteria, including age, education level, current disease comprehension, social status, patient beliefs, and cultural competence, influence patient compliance and must be considered. These characteristics have been shown to be excellent predictors of a patient’s compliance with medical/therapy orders/protocols. Patients/clients who are accustomed to daily behaviors such as following a diet, taking vitamins, and engaging in regular exercise find it simpler to adhere to medical protocols such as taking prescriptions, adhering to wound care dressings, and adhering to non-ambulatory orders. It has also been established that patients used to open and frequent communication with healthcare and medical practitioners exhibit greater compliance (Chittenden, 2022).
Reference
Chittenden, K. (2022). Patient Non-Compliance: A Barrier to Successful Outcomes in Medicine and Healthcare Service. Journal of Clinical Case Studies Reviews & Reports. SRC/JCCSR-198. J Clin Stud Rev Rep, 4(12), 2-4.
Cohen, N. A., Micic, D. M., & Sakuraba, A. (2022). Factors associated with poor compliance amongst hospitalized, predominantly adolescent pediatric Crohn’s disease patients. Annals of Medicine, 54(1), 886-892.
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Collapse SubdiscussionRita Osei response 1
Great read Andrea,
it is imperative to always consider the patient’s values and preferences in their care as it yields positive outcomes (Hofmann et al., 2014). In this scenario, I agree with you about engaging the patient in a discussion about his care and the pros and Cons of not adhering to the treatment. According to Melnyk & Fineout-Overholt (2018), patient-centeredness requires patient values and preferences to guide all decision-making aspects as it brings to light the need of the patient and his/her desires.
references
Melnyk, B. M., & Fineout- Overholt, E. (2018). Evidence-based practice in nursing &healthcare.
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
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Collapse SubdiscussionMaxine A Lewis Andrea I was very interesting reading your post regarding Andrea and it leads me to ask will there ever be a middle ground or is that the disease process is prohibiting Andrea from achieving that level of compliance? Its like “which come first the chicken or the egg?” In reality she really believes she is thinking logically.
Just a though I wonder if Andrea could would benefit from outpatient intervention also such as visiting mental health nurse my though is this: If she take a minimal amount to her med and is able to function for 2 years before being admitted just maybe education can be done when she is not in a crisis. Basically capitalized of the sub-optimal phase -she might be more motivated to learn as she has some clarity (meds onboard). Hopefully I am getting my point across lol.
Treatment delivery methods, patient and family traits, patient-clinician interactions, or treatment methods themselves may be the main causes of barriers that prohibit a partnership in treatment (From Noncompliance to Collaboration in the Treatment of Schizophrenia, 2009). So basically trying to established a partnership ( concordant approach) with Andrea in order to accomplish compliance. ” A concordant approach in patients with schizophrenia consists of: a collaborative approach to working with patients; giving patients information about their illness and treatment; tailoring medication regimens to suit the patient; use of compliance therapy techniques such as exploring ambivalence and testing beliefs about medications (Stewart, Anthony, and & Chesson, 2010).
References
From Noncompliance to Collaboration in the Treatment of Schizophrenia. (1990). Psychiatric Services: A Journal of the American Psychiatric Association, 41(11), 1203–1211. https://doi.org/10.1176/ps.41.11.1203Links to an external site.
Stewart, D. C., Anthony, G. B., & Chesson, R. (2010). ‘It’s not my job. I’m the patient not the doctor’: Patient perspectives on medicines management in the treatment of schizophrenia. Patient Education & Counseling, 78(2), 212–217. https://doi.org/10.1016/j.pec.2009.06.016
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Collapse SubdiscussionMaxine A Lewis Corrections made so reposting my response 2
Andrea it was very interesting reading your post regarding Andrea it led me to ask will there ever be a middle ground or is that the disease process is prohibiting Andrea from achieving that level of compliance? Its like “which come first the chicken or the egg?” In reality she really believes she is thinking logically.
Just a though, I wonder if Andrea could benefit from outpatient intervention also: such as visiting mental health nurse? My though is this: If she take minimal amount of her meds and is able to function for 2 years before being re-admitted then, just maybe education can be done when she is not in a crisis. Basically capitalized of the sub-optimal phase -she might be more motivated to learn as she has some clarity (meds onboard). Hopefully I am getting my point across lol.
Treatment delivery methods, patient and family traits, patient-clinician interactions, or treatment methods themselves may be the main causes of barriers that prohibit a partnership in treatment (From Noncompliance to Collaboration in the Treatment of Schizophrenia, 2009). So basically trying to established a partnership ( concordant approach) with Andrea in order to accomplish compliance. ” A concordant approach in patients with schizophrenia consists of: a collaborative approach to working with patients; giving patients information about their illness and treatment; tailoring medication regimens to suit the patient; use of compliance therapy techniques such as exploring ambivalence and testing beliefs about medications (Stewart, Anthony, and & Chesson, 2010).
References
From Noncompliance to Collaboration in the Treatment of Schizophrenia. (1990). Psychiatric Services: A Journal of the American Psychiatric Association, 41(11), 1203–1211. https://doi.org/10.1176/ps.41.11.1203Links to an external site.
Stewart, D. C., Anthony, G. B., & Chesson, R. (2010). ‘It’s not my job. I’m the patient not the doctor’: Patient perspectives on medicines management in the treatment of schizophrenia. Patient Education & Counseling, 78(2), 212–217. https://doi.org/10.1016/j.pec.2009.06.016
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Collapse SubdiscussionDiana Boreland-Warden Hi Andrea ,
I enjoyed reading your post. I agree that a major concern that many patients and practitioners encounter may be directly related to non compliance. I have worked in many settings in health care and find the most obstacles in mental health care. In a non-compliance example, many patients choose not to follow the instructions of the practioner and therefore may prolong the treatment cycle(Chittenden, K. , 2022). Issues with non compliance may be related to health care disparities and lack of resources. As you mentioned , a persons health care goals are directly related to their beliefs and in turn impact the outcome of their care. Patient-centered care, by contrast, invites patients to be active participants in their care. Patient-centered care emphasizes the patient’s experience with their illness( Siminoff,L. 2013).
References
Chittenden, K. (2022). Patient Non-Compliance: A Barrier to Successful Outcomes in Medicine and Healthcare Service. Journal of Clinical Case Studies Reviews & Reports. SRC/JCCSR-198. J Clin Stud Rev Rep, 4(12), 2-4.
Siminoff L. A. (2013). Incorporating patient and family preferences into evidence-based medicine. BMC medical informatics and decision making, 13 Suppl 3(Suppl 3), S6. https://doi.org/10.1186/1472-6947-13-S3-S6Links to an external site.Links to an external site.
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Collapse SubdiscussionErica Dentaa Darko Main Post*
Patient Preferences and Decision Making
I recall several situations from my past. I have about seven years of experience as a Registered Nurse. I’ve also traveled the country and worked in various nursing specialties. This comes with patient experiences, and each patient has a unique treatment plan. My experience with patient participation in treatment or healthcare decisions has been fascinating. In this discussion, I will elaborate on a situation that I have encountered.
In this case, the patient was admitted to the hospital following a recent stage 4 breast cancer diagnosis. She was a white female, age 53, and presented with increased excruciating pain in her left breast. Her name was not included due to HIPPA. Because the cancer was spreading quickly, immediate intervention was required. According to the patient’s treatment team, this patient was being followed by her hospitalist doctor and oncology doctor due to the need for immediate treatment. The oncology team advised the patient to have a mastectomy, a procedure to remove the breast.
On the other hand, the patient preferred to undergo a different procedure known as a lumpectomy. It is surgery to remove cancer or other abnormal tissue from the breast, which is what this surgery does. This guarantees that all abnormal tissue is removed. During a lumpectomy, the surgeon removes the cancer or other abnormal tissue and a small amount of healthy tissue surrounding it. The patient preferred that her breasts not be removed, but due to the rapid progression of her diagnosis, the doctors advised against it and told her it was in her best interests. Although she was worried and scared, as one might expect, the patient was adamant about what she wanted and refused the advice.
I tried to put myself in the shoes of this patient. The patient is in a lot of pain after being readmitted to the hospital and learning that she has aggressive cancer and that her doctors want to remove her breast. It was difficult to hear, and I could tell the patient was terrified. Overall, I believe the patient was preoccupied with some of her concerns, including body image, and I do not consider she was prepared for this change; I do not think the doctors fully understood or put themselves in the patient’s shoes.
They were solely concerned with removing the breast, ignoring the patient’s preference. Involving patients in decision-making always results in a better outcome (Melnyk and Fineout-Overholt, 2019). The care team educated and advised her that mastectomy has a better chance of lowering the risk of requiring additional surgeries and preventing recurrent breast cancer (Kummerow et al., 2015). Her chances of not requiring radiation therapy would improve if she had the mastectomy. A few interventions can be performed after a breast has been removed, which the patient was unaware of until it was clearly explained to them. As a result, a plastics consult was requested for future interventions. With more precise information and a better look at what life would be like after the surgery, the patient agreed to undergo the mastectomy. With more statements and a better idea of what life would be like after the surgery, the patient decided to have the mastectomy.
Overall, it is critical to consider patient preferences and values. The patient got a clear picture of her treatment plan after receiving additional patient education, resources, and different options. Using the decision aid from the Ottawa Hospital Research Institute is beneficial for health practices. Individuals and clinicians can read about diagnoses, compare treatment options, and take a quiz to understand their feelings better and guide their decision-making. It aids in the explanation of the inexplicable. This decision-aid inventory could be helpful in your professional or personal life.
References
Kummerow, K. L., Du, L., Penson, D. F., Shyr, Y., & Hooks, M. A. (2015). Nationwide trends in mastectomy for early-stage breast cancer. JAMA surgery, 150(1), 9-16.
Melnyk, M. B., & Overholt-Fineout, E. (2019). Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. (4th ed.). Philadelphia, PA: Wolters Kluwer.
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Collapse SubdiscussionAndrea M Allen Response 1
Hi Erica,
Interesting read. I am glad to hear there were more options provided to the patient. Loosing any body- part is a very delicate issue to anticipate. Most patients often want to know what are the choices or that maybe they can be the exception to the rule. It is quite hopeful for the patient to make the best decision regarding his/her care when all options are provided. We as nurses have to be quite resourceful to equip ourselves with as much knowledge to make the process easier for our patients. To provide patient with all possible options demonstrates patient is valued when they are able to have preferences.
Best,
Melnyk, M. B., & Overholt-Fineout, E. (2019). Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. (4th ed.). Philadelphia, PA: Wolters Kluwer.
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Collapse SubdiscussionSheila Ankrah Hi Erica,
Patient Preferences and Decision Making
Thanks for this week’s post. I completely agree with you that patient’s involvement in decision-making regarding their care depends on their cognitive and physical capacity, values, beliefs, knowledge, and emotional connections. Despite these assertions, some patients will still prefer not to get involved in their care decision-making due to one reason or the other. Biblical beliefs as you mentioned also play a vital role in the decisions that some people make. According to Say & Thomson, some patients may not want to participate in decision-making. This may be because they feel they lack the knowledge and experience to develop informed preferences and are afraid of making the wrong decision.
Nevertheless, it is thought that most patients want providers to understand their preferences even if they do not wish to make the final decision. But regardless of the patient’s choice, it is important to feed the patient with vital information regarding their treatment. Whatever the case may be, given a patient opportunity to choose is paramount; they deserve accurate, evidence-based information that includes the risks and benefits of their procedures (Lau et al., 2020).
References
Lau, B. C., Hutyra, C. A., Streufert, B., Reed, S. D., Orlando, L. A., Huber, J. C., Taylor, D. C., & Mather III, R. C. (2020). Surgeon Applications of Patient Preferences in Treatment Decision Making for First-Time Anterior Shoulder Dislocation. Orthopaedic Journal of Sports Medicine, 8(12), 1–9. https://doi-org.ezp.waldenulibrary.org/10.1177/2325967120966145Links to an external site.
Say, R. E., & Thomson, R. (2003). The importance of patient preferences in treatment decisions–challenges for doctors. BMJ (Clinical research ed.), 327(7414), 542–545. https://doi.org/10.1136/bmj.327.7414.542Links to an external site.
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Collapse SubdiscussionDiana Boreland-Warden Hi Erica ,
Your post regarding the patient with breast cancer immediately reminded me of a similar patient. When I first became an RN I encountered a patient in her late 30’s with stage 4 breast cancer. Her cancer was apparent and obvious. This particular patient made the decision to hide her diagnosis from her husband and family until she was no longer able to keep it a secret. Decision support tools that deliver patient preferences and personalized evidence-based outcome estimates improve the quality of decision making at the point of care(Lau et al , 2020 ) . The use of these tools in this situation may or may not have made a difference if offered. Unfortunately, she also decided to decline further treatment and her family was clearly not in agreement.
I was broken hearted for not only this patient but for her family as well. 9 years later as I reminisce on the decision she made I have more understanding and experience. “Some patients just don’t want to be involved.” Some patients may not want to participate in decision making. This may be because they feel they lack the knowledge and experience to develop informed preferences and are afraid of making the wrong decision. Nevertheless, it is thought that most patients want doctors to understand their preferences even if they do not wish to make the final decision( Say & Thomson , 2003).
References
Lau, B. C., Hutyra, C. A., Streufert, B., Reed, S. D., Orlando, L. A., Huber, J. C., Taylor, D. C., & Mather III, R. C. (2020). Surgeon Applications of Patient Preferences in Treatment Decision Making for First-Time Anterior Shoulder Dislocation. Orthopaedic Journal of Sports Medicine, 8(12), 1–9. https://doi-org.ezp.waldenulibrary.org/10.1177/2325967120966145Links to an external site.
Say, R. E., & Thomson, R. (2003). The importance of patient preferences in treatment decisions–challenges for doctors. BMJ (Clinical research ed.), 327(7414), 542–545. https://doi.org/10.1136/bmj.327.7414.542 Links to an external site.Links to an external site.
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Collapse SubdiscussionRita Osei Response 2
Hi Erica,
thank you for your post, as healthcare workers, we sometimes get caught up in doing the job that we tend to forget to assess whether the patients fully understand their treatment plan, and the risk involved. In the Scenario you presented, you can clearly understand the patient did not fully understand the procedure presented to her and that; there were alternatives to still feel like herself after having a mastectomy.
The value of patient decision aid is that they create educational awareness for all providers and patients. Healthcare workers can use this aid to help the patient better understand their treatment plan and also assess patients’ understanding of what is being presented to them.
Reference
A to Z summary Result- Patient Decision Aids- Ottawa Hospital Research Institute. 2019, from https://decisionaid.ohri.ca/AZsumm.ID=1112Links to an external site.
Melnyk, M. B., & Overholt-Fineout, E. (2019). Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. (4th ed.). Philadelphia, PA: Wolters Kluwer.
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Collapse SubdiscussionJasmine London Hi Erica,
Great post. I completely empathize with the patient in this scenario. It is great that the care team educated her on risks and interventions in depth. She was given knowledge on all of the different options and resources available. I agree using Ottawa Hospital Research Institute is a beneficial aid in health care. It helps people become involved in decision making by providing information on options and outcomes and by clarifying personal values (The Ottawa Hospital Research Institute, 2019). It is designed to accompany counseling from health care providers. As nurses, it is beneficial to have this additional aid to provide to patients with a tool that will help with decision making.
The Ottawa Hospital Research Institute. (2019). Patient decision aids. https://decisionaid.ohri.ca/
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Collapse SubdiscussionJordyn Simons The aim of patient-centered care is associated with individual patient preferences, needs, values, and decision making; and patient access to and receipt of information that permits well-informed health care decisions (McCabe et al., 2007). When any patient has a decision to make regarding a lifelong medication their input is vital to adherence. This is true for any chronic condition but especially true for the psychiatric population. People with chronic mental health conditions such as psychosis, schizophrenia, and bipolar disorder struggle with decisions about their use of antipsychotics. They often want to reduce the dose or stop, while facing uncertainty regarding the effects these decisions will have on their treatment and recovery (Zisman-Ilani et al., 2018).
Most often patients with a chronic mental illness will end up on an inpatient unit either being a danger to themselves or others. It is a huge barrier to get these patients to consider taking medication, let alone, adhere to taking them after discharge. I have many patients that become stable on an antipsychotic medication in an acute care setting, then be discharged, and within ten days they are back in the inpatient setting with similar symptoms. This is due to not taking their medications or even picking them up from the pharmacy after discharge. Although there as several issues causing this problem such as failure to educate and lack of community resources, a major is patient involvement in treatment planning and development.
I can recall a patient that was placed on an antipsychotic medication, Haldol, and started to have side effects. The psychiatrist prescribed Cogentin and with some relief of symptoms that patient was discharged and back within a short period of time. This could have been different if perhaps the doc changed, the patient’s medications and spent more time allowing the patient to be active in their treatment. Once on the medication and stable it is vital that these patents have a voice in their care moving forward.
When looking through the resources I found the “Antipsychotic Medication Decision Aid.” The This consists of a shared decision making via a encounter decision aid (EDA). The EDS includes option grids which consist of 5 common asked questions (benefits, risks, side effects, how it can affect usual life, etc.) about psychiatric medications. Each grid is individually tailored to the patient and or their family and was found to be valued and accepted by mental health patients (Zisman-Ilani et al., 2018). Through using this tool, taking the extra few minutes and discussing medication with patients, it can completely change their quality of life and outcomes. I can use this decision aid to help my profession practice at as PHMNP to allow my patients to feel heard and less stigmatized by mental health.
References
McCabe, O. L., Page, A. E. K., & Daniels, A. S. (2007). Improving health care for mental and substance use conditions: A framework for bridging the quality chasm. International Journal of Mental Health, 36(2), 65–79. https://doi.org/10.2753/imh0020-7411360206
Zisman-Ilani, Y., Shern, D., Deegan, P., Kreyenbuhl, J., Dixon, L., Drake, R., Torrey, W., Mishra, M., Gorbenko, K., & Elwyn, G. (2018). Continue, adjust, or stop antipsychotic medication: Developing and user testing an encounter decision aid for people with first-episode and long-term psychosis. BMC Psychiatry, 18(1). https://doi.org/10.1186/s12888-018-1707-x
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Collapse SubdiscussionLeslie Rasmussen Module 6 Discussion, reply 1.
Hi Jordyn!
I feel you on this post, I work in the emergency room, and we have frequent people that come in due to not taking their psych medications the way they were prescribed, its unfortunate. Its not even necessarily psych patients, only about 50% of medications are taken by the patient and many stops before treatment is even completed (Baumgartner et al., 2020). And unfortunately, the biggest problem in psych patients and having a poor response to their medications prescribed it because they do not take them correctly or stop taking them all together (Carvajal, 2022).
I think it is a great idea to use that decision aid, although these patients may have psych diagnosis, they are still human and should be involved in their care and medication treatments. I feel like with them being more involved, as well as family that you would have a better outcome. I give you props on wanting to go into the psych field, I get to deal with them on and off in the emergency department and it takes a special kind of nurse to specialize in just that!
References:
Baumgartner, A., Drame, K., Geutjens, S., & Airaksinen, M. (2020). Does the polypill improve patient
adherence compared to its individual formulations? A systematic review. Pharmaceutics, 12(2), 190. https://doi.org/10.3390/pharmaceutics12020190Links to an external site.
Carvajal, C. (2022). Poor response to treatment: beyond medication. Dialogues in Clinical Neuroscience,
6(1), 93-103. https://doi.org/10.31887/DCNS.2004.6.1/ccarvajal
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Collapse SubdiscussionAndrea M Allen Hi Jordyn,
I too work in Mental Health and feel very compassionate about the population. It’s amazing to see when a patient with Major Depression bounces back to good health which unfortunately does not happen very often. When it does, it’s like all the pieces are back in place and the patient evolves as if the illness never happened. I had one unique case of a pharmacist who had a car accident, lost her marriage, her homes, her hair, dropped out of school, because of major depression. When she came to our hospital, Unfortunately she was receiving treatment for psychosis in the acute setting but after hearing her story, the doctor started treating her for depression, she was able to return back to work, finished her Phd and picked up where she left off.
Some patients with psychosis have Anosognosia “lack of insight,” which makes it quite difficult to even comprehend what is going on with them much less to follow instructions such as how to take their medication, follow up with aftercare plan or avoid smoking or using other illicit drugs. These disadvantages are the reason for numerous readmission. I currently have a young lady who is 23yrs old with over 20 admission within the past two years to numerous hospitals and the first to where she is currently. In cases like these, even though ongoing education is implemented, these patients requires round the clock care for stability with enormous amount of support.
Siminoff L. A. (2013). Incorporating patient and family preferences into evidence-based medicine. BMC medical informatics and decision making, 13 Suppl 3(Suppl 3), S6. https://doi.org/10.1186/1472-6947-13-S3-S6
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Collapse SubdiscussionVictavian Jackson Initial Discussion Response
If nurses knew more about patients’ health-related preferences and values, care would be effective and closer to their wishes. As a way of supporting the consistent implementation of bedside handover, it is important to investigate patient preferences and values (Whitty et al., 2016, p. 742). For example, one in-denial patient I cared for in 2014 was newly diagnosed with diabetes. The patient was refusing to take any of their medication and learn from the diabetes educator how to self-manage their diagnoses on the patient portal. The patient would consistently state how confused they were about their care and never wanted to adopt new healthy lifestyle changes. Sometimes nurses may overload patients with information and overlook when patients’ emotions are making it hard to absorb decision-relevant information about their goals of care (Ubel et al., 2017, p. 31). On day 6, management encouraged bedside hand-off reports and after describing how the patient behaved toward the new diagnoses. A light bulb turned on and the patient clarified what exactly were we talking about; the nurse and I explained to the patient the goals of care and how he had not been receptive. As a result, his blood sugar has been out of control and would result in a longer stay at the hospital. The nurse and I spent 30 minutes at the bedside, but it was worth it because the patient made a 100% turnaround toward his diagnosis. From that day, the patient started taking his insulin, getting his blood sugar checked as the doctor ordered, and was receptive toward the diabetes educator. On discharge day, I asked the patient what made him stop refusing care. The patient said, “I wanted to be heard and not attacked by one person”. The patient started every morning off before he was sick planning his day with his wife and when the nurse and I came in the morning to wake him up to share his information, it opened his eyes to how much he preferred and valued being woken up, so he understands the plan. His confusion made him uncomfortable and in denial. Some of the most common reported nurse advantages of shift reports include improved report efficiency, teamwork, nursing accountability, and enhanced individual patient care (Dorvil, 2018, p. 21). The decision to wake the patient up for a bedside handoff report helped changed their perception of accepting their diagnoses. In the future, I will make it a priority during the admission process to verify the patient’s preference and values of care. I knew it was important but after seeing how impactful this can be in my professional practice, I will be aggressive in personalizing the care I deliver.
References
Dorvil, B. (2018). The secrets to successful nurse bedside shift report implementation and sustainability. Nursing Management, 49(6), 20–25. https://doi.org/10.1097/01.numa.0000533770.12758.44
Whitty, J. A., Spinks, J., Bucknall, T., Tobiano, G., & Chaboyer, W. (2016). Patient and nurse preferences for implementation of bedside handover: do they agree? Findings from a discrete choice experiment. Health Expectations, 20(4), 742–750. https://doi.org/10.1111/hex.12513
Ubel, P. A., Scherr, K. A., & Fagerlin, A. (2017). Empowerment failure: How shortcomings in physician communication unwittingly undermine patient autonomy. The American Journal of Bioethics, 17(11), 31–39. https://doi.org/10.1080/15265161.2017.1378753
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Collapse SubdiscussionCrystal Lewis Hi, Victavian,
Have you utilized patient decison aids, in your facilty? Are they available?
Good post!
Dr. Lewis
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Collapse SubdiscussionCassie L Bozard In the behavioral health setting, it is important to collaborate with the patient to create a treatment plan that the patient will be compliant with. If I don’t include the patients’ preferences, than the plan isn’t going to be individualized according to the patients’ specific mental health needs. Shared decision-making is a needed component of patient-centered care (Kon et al., 2016).
One part of my responsibilities as a Behavioral Health Navigator RN is to set up outpatient resources for patients through shared decision making. Shared decision making is joining the clinician and patient to discuss options, the benefits, harms, and consider the patient’s values and preferences (Hoffmann et al., 2014). My goal is to collaborate with the patient to create an effective and safe outpatient treatment plan that will benefit the patient’s mental well-being. I assess the patient’s needs, talk about the options, and build an effective treatment plan. Sometimes I discuss a plan that might be more beneficial, but the patient might not be willing to go that route based on certain circumstances. For example, I had a patient that wanted outpatient therapy regarding recent trauma. I assessed the patient and went over some of the outpatient treatment options. The patient would get the most benefit from a Partial hospitalization Program. This program is still outpatient. She would go to the location three times a week for an extensive period. This program offers medications management, individualized therapy, as well as group therapy. The patient did agree that this would be an excellent program to attend but the patient wasn’t willing to participate in the group sessions. Not attending group sessions was the patient’s preference, so I set her up with outpatient services that she was willing to participate in. There is no point in setting up a treatment plan if it doesn’t meet the patient’s preferences and willingness to be successful.
The patient decision aid that I selected that reflected the behavioral health setting is Depression. The type of treatment plan associated with depression depends on the patient’s values and priorities (The Ottawa Hospital Research Institute, 2019). In mild to moderate depression, it is suggested that the patient can choose an acceptable intervention or continue to watch for worsening depression symptoms because discussing intervention options (The Ottawa Hospital Research Institute, 2019). I honestly did not find the behavioral health topics to be of much benefit to me in my professional practice. If I had a medical condition, and I wanted to gain more insight, this platform might be beneficial.
References
Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision
making. Jama, 312(13), 1295-1296.
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in ICUs: An American College of critical care
medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188-201.
https://doi.org/10.1097/CCM.0000000000001396
The Ottawa Hospital Research Institute. (2019). Patient decision aids. https://decisionaid.ohri.ca/
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Collapse SubdiscussionBertina Boma Soh 2/10/2023
Reply to Cassie
Good day, Cassie. I enjoyed reading your article. It was interesting, and I admire your goal. You expressed that your goal as a Psych NP will be to work with the patient to develop an effective and safe outpatient treatment plan that will help the patient’s mental health. I am also a Behavioral Health Registered Nurse. I want to work in primary care and use my skills and expertise to promote patient health by focusing on illness etiology and using my APN leadership skills to create good working circumstances for nurses and other healthcare staff. As an Advanced Practice Nurse (APN), my primary goal is to encourage patient self-care and the adoption of good lifestyle choices that promote overall health and wellness. Over the last ten years, healthcare in the United States has undergone enormous reforms to give medical treatments to the uninsured, uncompensated, and low-income vulnerable people. In most places, treatment for these people begins in the emergency room. It extends far beyond the hospital to the outpatient sector, possibly necessitating continuous hemodialysis to preserve life, changing the concept of emergency medical problems for acute and long-term care, with financial resources allocated to manage this lengthy encounter (Applewhite, 2023). Considerations of autonomy in healthcare contexts tend to focus on instances in which decisions about healthcare interventions must be made. One of the principles of sovereignty is cited in talks concerning secrecy, faithfulness, privacy, and truth-telling. Nonetheless, it is most closely related with the notion that patients should be permitted or equipped to make autonomous decisions regarding their health treatment (Entwistle et al., 2010).
Patients should have a say in their healthcare decisions, and patient decision aids are an excellent method. They help patients feel more in control of their health care by giving them the information they need to make decisions, lowering stress, and improving the agency. Incorporating patient preferences and values into the decision-making process would have improved the situation’s trajectory and treatment strategy. If the patient had been allowed to participate in the decision-making process, they would have been able to make an informed decision about their treatment and the prospective outcome, and they would have been more likely to stick to the treatment plan.
References
Applewhite, T. (2023). COMPLIANCE WITH THE EMTALA [EMERGENCY MEDICAL TREATMENT & LABOR ACT] STATUTE IS THE KEY TO FINANCIAL SUCCESS FOR LOW-VOLUME AND UNDERFUNDED SAFETY-NET HOSPITALS. Journal of Health Care Finance.
Entwistle VA, Carter SM, Cribb A, McCaffery K. Supporting patient autonomy: the importance of clinician-patient relationships. J Gen Intern Med. 2010 Jul;25(7):741-5. doi: 10.1007/s11606-010-1292-2. Epub 2010 Mar 6. PMID: 20213206; PMCID: PMC2881979.
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Collapse SubdiscussionMaxine A Lewis Mr. Faitheart a 78-year male, retired pilot with a history of hypertension (diagnosed at age 50) ruled in for a myocardial infarct was found to have triple vessel disease. After consultation with cardiology, he was considered a suitable candidate for a CABG (Coronary Artery Bypass Graft), which he refused and opted for medical management saying he had a great life and would rather die at home than in the hospital. Now Mr. Faitheart was very independent and enjoys tennis 2-3 times per week but misses his wife of 50 year who died a year ago. The risk and benefits of the planned procedure were explained to him, but he remained adamant he did not want surgery but is agreeable to medical management as he is in total acceptance of his situation. Things changed when the family was informed of his decision and began pressuring him to have the surgery to which he finally agreed. He became the patient who experienced all the major complications possible, from v-fib in the OR to pressors, vented, trach, and pegged. Post extubation, he was delirious for days –diagnoses ICU psychosis. He was stabilized and sent to step-down only to return after a rapid response was called as he was found unresponsive aspiration of tube feeding; Mr. F 3 died days later.
Eviidence based medicine (EBM) and patient-centered medicine can be difficult to combine, especially when considering family preferences (Siminoff, 2013) as noted here in this scenario. Mr. Faithheart’s decision was accepting of his situation and made his choice which was disgarded due to family preference. One would argue that Mr. Faitheart changed his mind: However, did he really or was he bullied into consenting to the surgury? In this instance Mr. Faithheart decision should have been honored and if needs be an ethics meeting put into effect. Studies has showed that “elderly patients, compared with patients of a younger age group, present for surgery with a greater burden of risk factors and reduced functional levels. Short-term outcomes are hence poorer in them”(Natarajan et.al 2007). Mr. Faitheart original decision should have been respected and implemetation of a family meeting should have been done as well as a private meeting with the patient to decide how much of the medical information to share and how it should be delivered, as well as the risks and advantages of the proposed course of treatment (Smith, 2013). The family should have been cautioned on the possible negative outcome and possible guilt which will arise.
Initially I would have used the surgical decision decision aid i.e “Coronary Artery Disease: Should I Have Bypass Surgery?” (Healthwise Staff, 2023) to aid Mr. Faithheart in the decision process. Implementing a decision aid tool via paper, video, or web-based for shared decision making (SDM) is intended to help patients in matching personal preferences with available treatment alternatives. Research suggests that exposure to choice aids is linked to help in general trend away from surgery and toward medical care (Hurley et.al 2020). A surgical SDM aid tool would have helped Mr. Faitheart confidently make his decisions and help the family understand and respect his choice.
References
Healthwise Staff (2022). Coronary Artery Disease: Should I Have Bypass Surgery?
https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=av2037
Hurley, V. B., Rodriguez, H. P., Kearing, S., Yue Wang, Ming D. Leung, & Shortell, S. M. (2020). The Impact Of Decision Aids On Adults Considering Hip Or Knee Surgery. Health Affairs, 39(1), 100–107. https://doi.org/10.1377/hlthaff.2019.00100Links to an external site.
Natarajan A., Samadian S., Clark S. Coronary artery bypass surgery in elderly people.
Postgraduate Medical Journal 2007;83:154-158. https://pmj.bmj.com/content/83/977/154.full.
Siminoff L. A. (2013). Incorporating patient and family preferences into evidence-based medicine. BMC medical informatics and decision making, 13 Suppl 3(Suppl 3), S6. https://doi.org/10.1186/1472-6947-13-S3-S6
Smith, T.M. (2013). When patients, families disagree on treatment: 6 ways forward, https://www.ama-assn.org/delivering-care/ethics/when-patients-families-disagree-treatment-6-ways-forwardLinks to an external site.
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Collapse SubdiscussionNtumba Kabongo MAIN POST
I have had a mixed bag of results when patients were included in their care or decision-making. Some of the patients I’ve had the privilege of dealing with are highly involved in their care and well-informed enough to make deliberate decisions regarding their treatment. However, I have also dealt with patients whose knowledge of their illness was limited, making them hesitant to participate in their care. A patient decision aid has proven to be an invaluable tool in these situations for promoting collaborative decision-making (Hoffman et al.,2014).
The goal of patient decision aids is to arm patients with all the data they need to make educated choices about their healthcare. They give detailed explanations of the patient’s illness, available treatments, and expected consequences. Videos and quizzes are also featured to make the content more interesting and accessible to the target audience (Melnyk & Fineout-Overholt 2018). These decision aids can help alleviate patients’ concerns and encourage them to take an active role in their healthcare decisions by providing them with the data they need to make educated choices.
In my experience, healthcare providers can also benefit from patient decision aids. Healthcare personnel is better able to engage in meaningful interactions with patients when they are equipped with thorough knowledge about their disease and treatment options. This aids in making sure the patient is well-versed in their treatment and actively participating in their recovery. Patient decision aids have the potential to improve efficiency and cut down on expenses by decreasing the amount of time spent on patient education and consultations (Kon et al.,2016).
In my experience as an oncology nurse. I have seen a positive side of informing patients and letting them be involve in the decision making and I have seen the negative side when patient are made aware of the gloomy prognosis . In both circumstances, patient or sometimes family members make decision based on transparency of their treatments plan and the information at hand.
All things considered, patients should have a voice in their healthcare decisions, and patient decision aids are a terrific way to make that happen. They assist patients to feel more in control of their health care by giving them the facts they need to make decisions, as well as reducing their stress and increasing their agency. They can also facilitate more productive dialogues between doctors and patients, leading to better overall treatment.
References
Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision-making Links to an external site. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186
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 statement Links to an external site. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396
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)
Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice Links to an external site. Journal for Nurses in Professional Development, 32(4), 176–184. doi:10.1097/NND.0000000000000483
Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision-making Links to an external site. Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011. 00730.xThe Ottawa Hospital Research Institute. (2019). Patient decision aids Links to an external site. Retrieved from https://decisionaid.ohri.ca/
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Collapse SubdiscussionJordyn Simons Ntumba,
While reading your post I agreed with that statement, “healthcare providers can also benefit from patient decision aids.” Allowing patients to make an active decision improves patient knowledge regarding their options, reduces patients’ decisional conflict. PDAs increases patients’ active role in decision making. I believe that that are a great tool in starting a good conversation and improving communication with patient to improve rapport. When a provider forms rapport and makes an active effort to help a patient decide is allows trust to build in the profession patient/provider relationship. The optimal decision takes into account evidence-based information about available options, the provider’s knowledge and experience, and the patient’s values and preferences (The SHARE Approach—Achieving Patient-Centered Care with Shared Decisionmaking: A Brief for Administrators and Practice Leaders, n.d.).
Good luck next semester!
Jordyn
References
The SHARE Approach—Achieving Patient-Centered Care with Shared Decisionmaking: A Brief for Administrators and Practice Leaders. (n.d.). Www.ahrq.gov. https://www.ahrq.gov/health-literacy/professional-training/shared-decision/tool/resource-9.html
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Collapse SubdiscussionCrystal Lewis Hi, Ntumba,
Patients may not understand the evidence base underlying the decisions they are being offered. How do decision aids provide more education related to treatments based on research and their plan of care?
Great post!
Dr. Lewis
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Collapse SubdiscussionVictavian Jackson Great Post Ntumba,
I agree nurses do a great job of informing patients about their options for care. Nurses help patients use decision aids to improve their knowledge of their diagnosis, and their personalized expectations of what is important (Barry et al., 2022, p. 2). For example, at Regional Hospital provide patient portal access for newly diagnosed patients with diabetes to help manage their healthcare decisions and blood sugar control. I agree patients should have a voice in their healthcare decisions. Decision aids help patients clarify their values for outcomes of options by asking people to think about which positive and negative features of the options matter most to them; or describing each option to help patients imagine the physical, social, or psychological effects (Stacy et al., 2017, p. 2). When I researched the best feature of patient portals, patients valued the ability to request medication refills and the secure physician messaging tool. The ability of the patients to review their medical data help the patient in developing an opinion of what is their expectation of care. Great post!
References
Barry, M. J., Härter, M., Househ, M., Steffensen, K. D., & Stacey, D. (2022). What can we learn from rapidly developed patient decision aids produced during the covid-19 pandemic? BMJ, 1–5. https://doi.org/10.1136/bmj-2022-071530Links to an external site.
Stacey, D., Légaré, F., Lewis, K., Barry, M. J., Bennett, C. L., Eden, K. B., Holmes-Rovner, M., Llewellyn-Thomas, H., Lyddiatt, A., Thomson, R., & Trevena, L. (2017). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 2017(4), 1–287. https://doi.org/10.1002/14651858.cd001431.pub5Links to an external site.
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Collapse SubdiscussionCassie L Bozard Ntumba,
I enjoyed reading your post. Your thorough description on the value of patient decision aids helped me to fully understand the concept. Thank you for that!
You brought up an important concept. Patients want to feel more “in control” of their health care (Vahdat et al., 2014). Studies have suggested that patient participation in healthcare decisions empowers patients and improves services and patient outcomes. I’ve seen a big difference in how patients collaborate in their treatment plan when we give them options so they can make what decision is best for them instead of the treatment team telling them the appointments and services they need to participate in. I know when providers are in a hurry, they can at times say to patients after the assessment what they should be doing instead of going over the options for them to make the ultimate decision. Studies also show that engaging patients in their care is even more beneficial for the provider because the patient will be move compliant in services (Krist et al., 2017).
Krist, A. H., Tong, S. T., Aycock, R. A., & Longo, D. R. (2017). Engaging Patients in Decision-Making and Behavior Change to Promote
Prevention. Studies in health technology and informatics, 240, 284–302. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996004
Vahdat, S., Hamzehgardeshi, L., Hessam, S., & Hamzehgardeshi, Z. (2014). Patient involvement in health care decision making: a review. Iranian
Red Crescent medical journal, 16(1), e12454. https://doi.org/10.5812/ircmj.12454
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Collapse SubdiscussionUrsla Anyizi-Taku Second Response.
Hi Ntumba.
This is an exciting post.
I did further research and noticed that patient decision aids are a means of helping people make informed choices about healthcare that take into account their personal values and preferences. Decision aids are part of a shared decision-making process, encouraging active participation by patients in healthcare decisions (O’Connor et al., 1999). Decision aids are relevant in many everyday healthcare decisions. When patients are given decision aids, such as educational booklets, DVDs, or interactive tools, to help them make treatment choices, they are more knowledgeable and satisfied with their care. They have been developed to make it easier for patients and healthcare professionals to discuss treatment options. For patients, patient decision aids can alleviate the patient fears of asking questions or disagreeing if these tools effectively communicate that input is valued, educate them on the SDM process (Structured decision-making), and offer a deeper understanding of the risks and benefits of their treatment options ( Molenaar et al., 2000). Now some health systems and public policymakers are supporting the more widespread use of shared decision-making in efforts to promote patient engagement, reduce inappropriate use, and control costs.
Reference
O’Connor A, Rostom A, Fiset V, et al. Decision aids for patients facing health treatment or screening decisions: a Cochrane systematic review. BMJ 1999;319:731–4.
Molenaar S, Sprangers MA, Postma-Schuit FC, et al. Feasibility and effects of decision aids. Med Decis Making 2000;20:112–27.
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