Patient Preferences and Decision Making

In healthcare, one of the most important parts of the care plan to promote the best possible patient outcomes is the inclusion of the patient in their decision making. In Hoffman et.al.’s 2014 journal article, it is outlined how the combination of evidence-based medicine, patient-centered communication skills, and shared decision-making lead to optimal patient care (Figure 1). I have been able to witness in my own practice how including patients in their healthcare decisions has a huge impact on their overall outcome.

Working in an inpatient mental health facility has really shown me the value of including patients in their decision making, though sometimes it proves to be challenging if the patient does not have much insight into the severity of their mental illness. I actually was able to see this firsthand more recently in my facility. We had a patient who had been at our facility for quite some time who is considered gravely disabled due to their mental health symptoms. When planning for what would be best for the patient, the provider had decided that the best place would be our state mental health hospital. When the client was told this, the patient began yelling and posturing aggressively towards staff though the patient had been nothing but pleasant for the month plus they had been at our facility. Immediately, we knew something was wrong. We sat down with the patient and asked them to share what they were feeling. The patient explained that they did not want to go to the state hospital because they had been there before and did not have a good experience. The patient continued to explain that they had gone to this facility during the prime of COVID and it felt like a prison, they were quarantined to their rooms and were not allowed to have visitors. This was a tricky situation because this client was gravely disabled and the state hospital was the best option for this patient to help manage their illness, but we did not want it to be not a therapeutic option if the client was this resistant of the facility. So, we called the state hospital to see what the status of their COVID restrictions were and found out that they are much less restrictive than the last time the patient was there. When the patient was told this, we were then able to slowly acclimate the patient to the idea of going to the state hospital once accepted off of their waitlist and made the transition much easier as the patient was eventually excited to go.

Many things were learned from this experience. By including the patient’s beliefs and values into the decision making regarding their cares, we were ultimately able to get the patient to be more open to going to the state hospital and will therefore have an overall better experience and outcomes at the state hospital if they are more willing to engage in their treatment. In Krist et.al.’s 2017 journal entry, it is described how including patients in decisions for their care will lead to better patient outcomes and more compliance (para. 7). The hope for the patient that I described is that because we included their feelings into the plan, they will be more willing to engage in the treatment at the state hospital that will be able to provide them with the necessary skills to manage their mental health symptoms outside of a facility setting.

Using The Ottawa Hospital Research Institute’s 2019 patient decision aids, I identified the Ottawa Personal Decision Guide as an tool that I both could’ve used in the situation described above as well is in my personal and professional practice. The tool allows for a person to identify options they have for themselves and the pros and cons of each. The tool also allows the person to identify the knowledge, the values, and the support the person has in this decision making. This tool will aid a person in making an informed decision for themselves in a way that allows them to feel like they are included in the decision making, even if ultimately it is not the one the thought they would have wanted but were able to weigh the pros and cons and eventually make an informed decision that is best suited for them or at least understand why a treatment team feels it is the best for them.

References

Hoffman, T.C., Montori, V.M., & Del Mar, C. (2014). The connection between evidence-based

medicine and shared decision making. Journal of the American Medical Association,

312(13), 1295-1296. doi:10,1001/jama2014.10186.

Krist, A. H., Tong, S. T., Aycock, R. A., & Longo, D. R. (2017). Engaging patients in decision-

making and behavior change to promote prevention. Studies in health technology and

informatics. Retrieved November 3, 2022, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996004/

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from

https://decisionaid.ohri.ca/AZsearch.php?criteria=psych.

Learning Resources

REQUIRED READINGS

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)

Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. 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. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396

Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. 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. Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.x

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/

OPTIONAL RESOURCES

Review these instructions for guidance on how to create a narrated PowerPoint presentation.
https://support.microsoft.com/en-us/office/record-…