I need to reply to this discussion, here is the main question in case you need it.
Patient Preferences and Decision Making
Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.
What has your experience been with patient involvement in treatment or healthcare decisions?
In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.
To Prepare:
- Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
- Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.
- Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.
NOTE:To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.
Patient Preferences and Decision Making
Patient-centered care has been defined as “Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions” (Institute of Medicine). It is not uncommon that health care professionals approach patients as if they know what is best for the patient and never consider patient preferences, beliefs, home situations, financial situations, religious beliefs, and so many other factors that influence personal choices they make and want to make. As healthcare providers we need to remember to present the options and then respect the decision, understanding that what might be right for us and to us may not be right for someone else. As much as clinicians like certainty, uncertainty is part of healthcare decision making (Kamhi).
Clinical Experience
One area that seems to be particularly difficult for some healthcare professionals to keep their personal opinions and beliefs out of a patient right to choose is in the area of genetics. Laura had family members with a heart defect that was found out later in their lives as adults, the RYR2 gene, or CPVT (Catecholaminergic Polymorphic Ventricular Tachycardia) and she decided to be tested. Her test came back positive, so she found a cardiologist that specialized in electrophysiology to consult and begin treatment for the gene. In their first meeting, the specialist asked if she was on birth control and Laura stated that she was not. The physician went on to counsel her that she should not have any children because of the gene and the fact that she had a high probability of passing it to any children she may have. Laura was a 24-year-old who wanted nothing more than to become a mother and without knowing what her values, hopes, and dreams were, the physician crushed her dreams. Laura was so upset that she left her appointment and never returned again. This has put her at extreme risk as she could have an event like her brother had and die from it. Her brother was fortunate that a nurse was present and was able to start CPR right away and is still living to tell his story. Laura on the other hand, needs to consider a pacemaker/defibrillator as well as medication and has delayed seeing another physician because of her experience with the first specialist she saw.
How Does Involving or Not Involving Patients Preference Effect Clinical Outcome
There are so many possible outcomes when as healthcare professionals we involve or don’t involve patient preferences and allow them to make their own choices. In the scenario above it could cost a young girl her life. It is difficult sometimes to forget it is our job to present the facts, give the options, respect the decision even if we do not agree, and avoid being judge-mental if they don’t choose what we want them to. Dr. Cuthbertson said something similar well today when we were reviewing the day we had, “it is not always easy for clients to make what we think are simple good choices because life gets in the way and the circumstances such as family issues and obligations, work commitments, financial needs and worries, experiences, traumas, and personal beliefs that make it all so very complicated.” This physician, in my opinion, should have spent the first visit getting to know Laura, built some trust presented options, and then discussed pregnancy at a later appointment, after all, pregnancy was not the primary issue nor the issue she was being seen for at that visit. Perhaps giving her the Ottawa Personal Decision Guide along with her options so that he could have learned more about his patient, and she could make good decisions for herself. This physician failed her because she did not hear anything else or the choices, she did have to make about the care for her RYR2 gene.
The Ottawa Personal Decision Guide could have been used to inform her about the health condition, options, and possible outcomes of options using the latest quality-rated scientific evidence, clarified her personal values or importance of the benefits and risks or side effects of options. Shared decision making is the process of clinician and patient jointly participating in a health decision after discussing the options, the benefits, and harms, and considering the patient’s values, preferences, and circumstances (Hoffmann, Montori, and Del Mar). The physician Laura saw did not understand that he needed to include her in the health decision after discussing the options and what the possible outcomes could be.
Conclusion
Health care providers need to remember we are not responsible to make decisions for our patients or push our preferences or judgments onto our patients, it is our job to give them the options and information they need to decide.
References
Hoffmann TC, Montori VM, Del Mar C. The Connection Between Evidence-Based Medicine
and Shared Decision Making. JAMA. 2014;312(13):1295–1296.
doi:10.1001/jama.2014.10186
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century.
Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25057539
The Ottawa Hospital Research Institute. (2019). Patient decision aid. Retrieved from
Kamhi, A. Balancing Certainty and Uncertainty in clinical practice. Language, Speech, and
Hearing Services, 42, 88-93.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare:
A guide to best practice (4th ed.). Chapter 7 (pp 219-232).
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