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DISCUSSION: PATIENT PREFERENCES AND DECISION MAKING

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.

Guide for Writing a Clinical Reflection Paper

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.

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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.

Module 6 Initial Discussion Post

Within the realm of genetic mutations, BRCA 1 and BRCA 2 stand out as significant contributors to an elevated risk of breast, ovarian, and other cancers, particularly among the younger population (Collins & Isaacs, 2020). Individuals grappling with these genetic variants often find themselves navigating complex decision-making processes aimed at reducing their susceptibility to these formidable diseases (Kautz-Freimuth et al., 2021).

To illustrate the patient’s perspective, I will draw upon my own experience. At the age of 25, I received a diagnosis of the BRCA 2 gene mutation. I deliberately postponed genetic testing until after having children, fully aware that I would not consider any interventions until then. When the results confirmed the presence of the gene mutation, I engaged an entirely new team of healthcare professionals to delve into the multifaceted aspects of this genetic anomaly.

My role in the decision-making process was highly active, encompassing my personal preferences and priorities. Faced with the options of undergoing biannual screenings or opting for a double mastectomy and hysterectomy to mitigate the risks, I chose the surgical path given my family’s history. I believed that regular screenings, while valuable, primarily aimed to detect cancer early rather than prevent it. The odds of developing cancer were considerable, leading me to opt for proactive measures. My healthcare decisions were shaped by a multitude of factors, including the type of hysterectomy, the specific mastectomy procedure and implant placement, the timing of these surgeries, and my overriding sense of control in managing my health. Importantly, my medical team fully supported my choices.

In reviewing the provided references, I explored the topic of breast cancer screening, which aligns with the subject at hand. The decision aid featured in these references, DynaMed Decisions, emerges as a valuable clinical resource. This tool offers evidence-based information and resources designed to empower patients to make patient-centered, personalized decisions (EBSCO, 2023). DynaMed Decisions comprises two key areas: clinical decision smart tools that deliver evidence-based tools and information to guide informed decision-making, and shared decision-making tools that address frequently asked patient questions and assist in the selection of the most suitable decision-making tools (EBSCO, 2023). This tool holds immense potential for patients, as it equips them with the requisite information to make informed choices, remains continually updated with the latest evidence-based information, and addresses common queries, thereby providing clarity for those who might be uncertain about where to commence their decision-making journey. Personally, I believe that such a resource would have significantly aided me in my own decision-making process. I recall relying heavily on Google to obtain answers, which often led to confusion due to the multitude of sources offering varying information. Having a centralized platform that furnishes readily available and comprehensive data and insights would have greatly eased my decision-making process. If I were to revisit that period, I would unquestionably leverage such a resource.

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

Reply to Comment

Response #1

Hello Leslie, I want to commend you for your significant involvement in such a noble cause, both for yourself and your family. As someone who has been an oncology nurse for many years, I understand how our personal experiences can profoundly influence our decision-making in our personal lives and subsequently impact our approach to patient care.

Recognizing that patients have the right to be informed and actively participate in decisions about their care is essential. Through my experience, I’ve witnessed both the positive and challenging aspects of involving patients in their care decisions, which can be particularly complex at times. Integrating patient preferences and values into the decision-making process is pivotal in tailoring interventions to specific conditions, ultimately facilitating personalized care (Melnyk & Fineout-Overholt, 2018).

I’m intrigued by the reference to DynaMed Decision, the decision support solution you mentioned. This system appears to offer valuable tools that can enhance clinical decision-making, thus alleviating the burden on healthcare providers (EBSCO, 2023). By providing evidence-based resources, it empowers healthcare professionals to deliver patient-centered and personalized care effectively. It’s an approach that aligns well with the principles of patient involvement and personalized healthcare.

    • Collapse SubdiscussionMaxine A Lewis 

      Maxine A Lewis

      Manage Discussion Entry

      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

       Reply to Comment

    • Collapse SubdiscussionJasmine London 

      Jasmine London

      Manage Discussion Entry

      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

       Reply to Comment

    • Collapse SubdiscussionSulaiman Yassin Jalloh 

      Sulaiman Yassin Jalloh

      Manage Discussion Entry

      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

       Reply to Comment

    • Collapse SubdiscussionMleh Porter

      Mleh Porter

      Manage Discussion Entry

      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

       Reply to Comment

Patient Preferences and Involvement in Decision Making

In the contemporary and highly advanced healthcare system, the prominence of patient preferences and their active involvement in decision-making processes is evident in numerous healthcare institutions. Hospitals, recognizing the profound impact on healthcare delivery, patient experiences, cost considerations, and the overall quality of care, have placed a strong emphasis on enhancing patient engagement. A central aspect of this emphasis is the effective communication between healthcare professionals and patients, facilitating shared decision-making processes. While involving patients in decisions regarding their care poses challenges, healthcare providers can address this by offering training and empowering their staff with the skills needed to engage patients effectively.

Experiences with Patient Participation in Healthcare Decision-Making

Drawing from my clinical experience as a nurse in an intensive care unit, I have encountered both favorable and challenging situations involving patient participation in healthcare decisions. Throughout my clinical practice, engaging patients in decision-making has demonstrated positive outcomes, significantly reducing the time nurses spend on non-clinical tasks (Kon et al., 2016). An illustrative example from my experience relates to cases where patients who could articulate their symptoms actively participated in discussions about their condition. In such instances, their stays in the intensive care unit were notably shorter compared to patients in comatose states. Evidently, involving patients in the decision-making process benefits healthcare by facilitating more informed choices regarding the most suitable treatment options, given the patients’ familiarity with their symptoms. However, it’s essential to acknowledge that there are situations where patient involvement could potentially lead to adverse outcomes. For instance, if a patient insists on reducing their medication dosage because they feel better, complying with their request may have detrimental effects on their health. In summary, the benefits of patient involvement in decision-making outweigh the drawbacks, making it a crucial aspect of modern healthcare.

The Significance of Patient Decision Aids in Guiding Best Practices for Patient Care and Healthcare Decision Making

Patient Decision Aids hold a pivotal role in shaping best practices within healthcare by providing invaluable assistance to patients navigating the complex landscape of pharmaceutical data and research related to their treatment plans. These aids offer critical guidance to patients, enabling them to make well-informed decisions concerning their treatment options and the associated costs (The Ottawa Hospital Research Institute, 2019). This level of insight empowers patients to select the most appropriate healthcare choices tailored to their individual needs. Furthermore, Patient Decision Aids present a comprehensive overview of the potential benefits and risks associated with these decisions, rooted in evidence-based information (Melnyk & Fineout-Overholt, 2018). Additionally, they furnish information about complementary treatments that could enhance outcomes, particularly for patients seeking more comprehensive or specialized care beyond the scope of their primary care physician. In essence, Patient Decision Aids enable patients to make informed decisions by providing a deeper understanding of their medications and a comprehensive awareness of the risks and benefits associated with following their physician’s recommendations.

Conclusion

Effective training equips healthcare providers to engage patients in their treatment plans successfully. My clinical experiences have underscored the dual nature of patient involvement, with both positive and negative outcomes. Moreover, the role of Patient Decision Aids in empowering patients to comprehend their treatment regimens, including the associated risks and benefits, is undeniably significant. Healthcare institutions should prioritize the integration of Patient Decision Aids, recognizing their pivotal role in enhancing 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/

       Reply to Comment

        • Collapse SubdiscussionUrsla Anyizi-Taku 

          Ursla Anyizi-Taku

          Manage Discussion Entry

          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.

           Reply to Comment

      • Collapse SubdiscussionSulaiman Yassin Jalloh 

        Sulaiman Yassin Jalloh

        Manage Discussion Entry

        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.

         Reply to Comment

      • Collapse SubdiscussionMleh Porter

        Mleh Porter

        Manage Discussion Entry

        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/

         Reply to Comment

  • Collapse SubdiscussionAndrea M Allen

    Andrea M Allen

    Manage Discussion Entry

    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

     Reply to Comment

    • Collapse SubdiscussionBertina Boma Soh

      Bertina Boma Soh

      Manage Discussion Entry

      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.

       Reply to Comment

    • Collapse SubdiscussionRita Osei

      Rita Osei

      Manage Discussion Entry

      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

       Reply to Comment

      Collapse SubdiscussionMaxine A Lewis

      Maxine A Lewis

      Manage Discussion Entry

      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

       Reply to Comment

      • Collapse SubdiscussionMaxine A Lewis

        Maxine A Lewis

        Manage Discussion Entry

        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

         Reply to Comment

    • Collapse SubdiscussionDiana Boreland-Warden 

      Diana Boreland-Warden

      Manage Discussion Entry

      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. 

       Reply to Comment

  • Collapse SubdiscussionErica Dentaa Darko 

    Erica Dentaa Darko

    Manage Discussion Entry

    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 

      Andrea M Allen

      Manage Discussion Entry

      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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