NURS-6052 DISCUSSION: PATIENT PREFERENCES AND 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.
Initial Discussion Post
Discussion: Patient Preferences and Decision Making
Incorporating patients’ preferences and values gives the patients an active role in their care. Enable patients to offer opinions and participate in their treatment-related decision-making—is needed and could lead to more efficient and effective health care (Siminoff, 2013). Studies show that effectively engaging patients in their care are essential to improve health outcomes, improve satisfaction with the care experience, reduce costs and even benefit the clinician experience (Krist et al., 2017). The authors added that patients who participate in their decisions report higher satisfaction with their care; have increased knowledge about conditions, tests, and treatment. In addition, they have more realistic expectations about benefits and harms; are more likely to adhere to screening, diagnostic, or treatment plans; have reduced decisional conflict and anxiety; are less likely to receive tests or procedures which may be unnecessary; and, in some cases, even have improved health outcomes.
In my professional practice, I have come across a scenario that highlighted the value of shared decision-making and providing patients with adequate information that led to quick medical intervention that saved the patient’s life. My personal experience is about a 34-year-old female patient who came to our office sometime early last year. Based on the patient’s history and other factors, I realized the patient might be at risk of developing breast cancer. We discussed the importance of breast self-examination and how it may be helpful in early breast cancer detection. No single test can detect all breast cancers early, but performing breast self-exam combined with other screening methods can increase the chance of early detection (Breastcancer.org, 2019). I taught the lady how to perform the examination. In the course of her self-examining of her breast, she discovered a lump in her left breast four months after. Without hesitation, the patient called the doctor’s office, where a physical examination of the breast was done. The doctor ordered breast imaging tests. In the end, the test revealed that the lump was cancerous. By involving the patient in her care, early detection was possible without any metastasis.
According to patient decision aids for women at high risk for breast cancer, she should get extra checkups and testing, take medicines as prescribed, have surgery to remove both breasts or have surgery to remove her ovaries. Presenting available breast cancer treatments to the patient will enable her to make the best decision once presented with all the necessary information. I will most definitely be using this decision aid checklist when assisting patients in decision-making in the future.
References
Breastcancer.org (2019). Breast self-exam. Retrieved May 12, 2021, from https://www.breastcancer.org/symptoms/testing/types/self_examLinks 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. Studies in health technology and informatics, 240, 284–302.
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.
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Collapse SubdiscussionJordyn Simons
Jordyn Simons
Feb 8, 2023Feb 8 at 1:45pm
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Shelia,
Thank you for your post. It is awesome that you were able to identify needs, advocate, ,and help that patient with her care! Patient decision Aids (PDAs) are tools that help patients and providers talk together about care options. PDAs help patients understand their choices about whether to have a specific treatment or screening. This includes knowing the pros and cons of each available option. Exploring all options allows a patient to feel more relaxed and less anxious about any upcoming test or procedure. PDAs also provide patients with information needed to decide, based on their personal values and preferences, by exploring each option and how it relates to their values. Research shows that PDAs lead to increased knowledge and a more accurate understanding of risk. When using a PDA, more patients feel comfortable with the decisions they make and the care they receive (Washington State Health Care Authority, n.d.). For example, a PDA could help a pregnant woman decide whether to attempt a natural birth after having a cesarean. We can use PDAs to form meaningful connects with patients by allowing them to feel knowledgeable and heard.
Good luck with the rest of your journey at Walden!
Jordyn
References
Patient decision aids (PDAs) | Washington State Health Care Authority. (n.d.). Www.hca.wa.gov. Retrieved from https://www.hca.wa.gov/about-hca/programs-and-initiatives/making-informed-health-care-decisions/patient-decision-aids-pdas#can-i-use-the-pdas-on-this-page
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Collapse SubdiscussionLeslie Rasmussen
Leslie Rasmussen
Feb 9, 2023Feb 9 at 5:50pm
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Module 6 Discussion, reply 2.
Hi Sheila!
This one hit close to home as I wrote about my genetic testing done and risk for breast and ovarian cancer, I opted for a double mastectomy at 25 and a full hysterectomy at the age of 27. It was a lot, but you are correct, imaging does not always work and its important to know the risks and what to look for. Thankfully you took the time do complete this teaching because it could have been a lot worse for this patient, she may never of known her risk without you looking into it further. Some individuals don’t pay attention to that type of thing or know what really affects the different types of cancer before it is too late. Realizing patients have a higher risk of breast cancer due to their family history is one big step in planning their future care so that way they can go in the right direction (Huber-Keener, 2022). Completing a self-exam is at no cost and no risk to yourself to improve mortality when it comes to breast cancer (Huang et al., 2022). I have done so much research on breast cancer just due to my risk and genetic mutation, but it was so hard to believe that it’s the leading cancer in American women and that every 2 minutes someone is being diagnosed with breast cancer (Huang et al., 2022). I have found that involving patients directly in their care, teaching them hands on has had so much benefit for better adherence and compliance to their treatments and their health all together.
References:
Huang, N., Chen, L., He, J., & Nguyen, Q. (2022). The efficacy of clinical breast exams and breast self-
exams in detecting malignancy or positive ultrasound findings. Cureus, 14(2). doi:
10.7759/cureus.22464
Huber-Keener, K. (2022). Cancer genetics and breast cancer. Best Practice & Research Clinical Obstetrics
& Gynaecology, 82, 3-11. https://doi.org/10.1016/j.bpobgyn.2022.01.007Links to an external site.
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Collapse SubdiscussionChristiana Nuworsoo
Christiana Nuworsoo
Feb 9, 2023Feb 9 at 8:12pm
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Sheila,
Way to go! With your diligence and assistance, you were able to help the patient help herself. Recent reports from several US studies show that coordinated care trials that actively involved patients with chronic diseases led to significant mortality reductions when compared to a control group that merely took the recommended drugs (Krist et al., 2017). I genuinely think that all patients should have some degree of control over their medical treatment. Even a patient who suffers from a mental illness is aware that they ought to be given the opportunity to make decisions, no matter how minor. When the patient is involved, medical information that is no longer pertinent to them may occasionally be changed. I’ve encountered a number of instances when a patient’s medication list still included an ineffective drug, but since the patient was not participating in their treatment, the drug was added to the daily list of medications. I learned that the patient no longer takes the drug through education before administering it.
References
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.
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Collapse SubdiscussionAmanda Sutherland
Amanda Sutherland
Feb 11, 2023Feb 11 at 10:46pm
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Response #2
Hello Sheila, thank you for your post. I wanted to expand on your discussion of patient decision aids (PDA) by describing a major source where we can find a range of PDA as described by Melnyk and Fineout-Overholt (2018), the Patient Centered Outcomes Research Institute (PCORI). PCORI was created in 2010 with the Affordable Care Act and reauthorized in 2020. It receives funding through the federal government and a $2 charge per insured person on Medicare, private insurance, and self-insured plans. Every year it awards research funding primarily for patient-centered clinical effectiveness research (CER) where the outcomes of 2 or more interventions, practices, or services are compared (Patient Centered Outcomes Research Institute, 2023). When I searched ‘patient decision aid’ on PCORI’s internet site, I received 126 results and found an article by Gayer et al. (2016) which includes a listing of the 56 decision aids in a variety of practice areas created through PCORI funding at the time of publication. The article also discusses strategies for increasing dissemination and implementation of decision aids by institutions, which the researchers note lags behind government-funded creation (Gayer et al., 2016).
References
Gayer C., Crowley M., Lawrence W., Gierisch J., Gaglio, B., Williams, J., Myers,, E., Kendrick, A., Slutsky, J., Sanders, G. (2016). An overview and discussion of the Patient-Centered Outcomes Research Institute’s decision aid portfolio. Journal of Comparative Effectiveness Research. Jun 14. PubMed PMID: 27298206.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
Patient Centered Outcomes Research Institute. (2023). About PCORI https://www.pcori.org/about/about-pcori
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Collapse SubdiscussionCrystal Lewis
Crystal Lewis
Feb 12, 2023Feb 12 at 3:50pm
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Hi, Sheila,
As you have explored decison aids, do you believe decision aids have any impact on patient satisfaction? Why is this important to consider?
Great post!
Dr. Lewis
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Collapse SubdiscussionRita Osei
Rita Osei
Feb 7, 2023Feb 7 at 10:52am
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Initial post
I recently witnessed a situation where a patient was not brought into the decision regarding their treatment plan. The patient was a young man in his twenties who had been diagnosed with a rare form of cancer that had an extremely poor prognosis. The patient’s family was very involved in the decision-making process, but the patient himself was not consulted. The family decided to go with the most aggressive treatment option, which was a risky and invasive procedure with a poor chance of success.
The lack of patient involvement in the decision impacted the outcome of the treatment plan in several ways. First, it led to an unbalanced decision-making process, where the patient’s wishes and values were not taken into consideration. Second, it meant that the patient did not have the opportunity to make an informed decision about the risks and benefits of the procedure, and the potential for a successful outcome. Finally, the lack of patient involvement in the decision led to a feeling of helplessness on the part of the patient, who was not given the chance to be part of the decision-making process.
Including patient preferences and values in the decision-making process would have had a positive impact on the trajectory of the situation and the treatment plan. The patient would have been able to make an informed decision about their treatment and the potential outcome, and they would have been more likely to adhere to the treatment plan if they had been allowed to be part of the decision-making process. Additionally, the patient would have felt more empowered and in control of their situation.
The value of the patient decision aid I selected is that it provides clear and concise information about the patient’s condition and the potential treatment options, as well as the potential risks and benefits of each option. This helps to ensure that the patient is making an informed decision and that the care provider is considering all of the patient’s wishes and values when making a recommendation. Additionally, the patient decision aid can help to ensure that the care provider is practicing evidence-based care.
I believe that the patient decision-aid inventory is an invaluable resource for both care providers and patients. For care providers, it provides a way to ensure that they are providing evidence-based care and taking into consideration the patient’s wishes and values in the decision-making process. For patients, it provides a way to make an informed decision about their care and to feel more empowered and in control of their situation. I plan to use the patient decision-aid inventory in my professional practice to ensure that I am providing evidence-based care and taking the patient’s wishes and values into consideration in the decision-making process.
References
Melnyk. B. M. & Fineout-Overholt, E. (2018) Evidence-based practice in nursing & he
