Patient Preferences and Decision Making

Week 11NURS Essent of Evidence-Based Practice RESPONDs RESPOND to 2 STUDENTS: 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/. “Tutor read my discussion paper below” o 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. • 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. Student #1 CP RE: Discussion – Week 11 C OLLA PSE Week 11 Main Discussion Post Working in the ICU for 19 years has given me great experience with both evidence-based medicine (EBM) and shared decision-making (SDM). EBM and SDM are both very important and dependent on each other when discussing treatment options and possible end of life care in the ICU. (Hoffman, Montori, & Del Mar, 2014) It is not possible to give patients/surrogates the best treatment options to choose from if you don’t have the most up to date evidence-based research available to them. Shared decision-making is a collaborative process that allows patients, or their surrogates, and clinicians to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. Patient Preferences and Decision Making

(Kon, Davidson, Morrison, Danis, & White, 2016) I have seen countless situations where older people (greater than 75) have either not had advanced directives in place or the advance directives have been ignored by the health care surrogate or family members/next-of-kin. It makes it very for hard for clinicians to do what is best for the patient at the end of life. Most health care surrogates/family members really want to do what is best for the elder family member, but being from FL and having a large population of retirees we have seen some really sad cases of decision-making processes. I will never forget a man that I took care of one time that was in ICU on a ventilator, he was in multi organ failure and the physicians had spoken with the wife several times regarding treatment options as well as end of life care. He did not have an advanced directive. She was adamant on keeping the patient alive. Once the patient had a tracheostomy, the patient was taken off sedation and returned to being alert and oriented. By this time he had been in the ICU for two months. The patient could not move due to muscle wasting and third-spacing, his skin was weeping due to the tightness, he had a large, painful open-wound on his coccyx, and every day he asked us to let him die. His wife who was his health care surrogate stated “I don’t care what he wants, if you let him die, I will sue you!” We spent another month taking care of this patient and every day he asked us to let him go. He finally ended up coding and past away. The ethics committee had been involved and the reason the wife wanted to keep him alive was that she was unemployed, didn’t qualify for Medicare for another three years and was living off his SS check. These types of cases make it very hard for clinicians as they happen more often than people realize. After this case, I have spoken to every patient that I have admitted to ICU and their families about the importance of an advance directive and speaking to family members about their wishes before being in a tough situation. In the Ottawa Hospital Research Institute’s Decision Aid Inventory (OHRI, n.d.) it has an “Understanding the options: planning care for the critically ill patients in the Intensive Care Unit.” This booklet should be given to every patient admitted to the ICU or their family member. It is very useful in explaining options and having the family members approach the subject with the patient if able or reflect on what they feel the patient would have wanted if they could speak for themselves without waiting until the decision needs to be made immediately. SDM is such an important part of patient care, yet patients and family members have never thought about having to make decisions like these when the time comes. It is so important to know the patient’s values, goals, and preferences for what they want when they get older, so that they can control their end-of-life decisions. References Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). Patient Preferences and Decision Making

The connection between evidencebased medicine and shared decision making. JAMA, 312(13), 1295– 1296. https://doi.org/10.1001/jama.2014.10186 Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in icus. Critical Care Medicine, 44(1), 188– 201. https://doi.org/10.1097/ccm.0000000000001396 Understanding the Options: Planning care for critically ill patients in the Intensive Care Unit [PDF]. (n.d.). decisionaid.orhi.ca. Retrieved February 8, 2021, from https://decisionaid.ohri.ca/docs/das/Critically_Ill_Decision_Support.pdf Student #2 KB RE: Discussion – Week 11 C OLLA PSE Working in the intensive care unit for six years, I have had the opportunity to be involved in thousands of different cases, involving different doctors, patients, and families. I see from both a physician’s side and a family members side of involving the family in medical decisions right away or not. With the physician’s side, this sometimes involves sitting down with a family with no medical background and having difficulties answering questions or explaining things while the course of treatment is pretty basic. From a family’s point of view, they might want to be involves in the patients care right away because the patient themselves only want certain things done in order to save their life. I had the opportunity to be involved in a case where the physician would not allow the family to listen in on the daily rounding and the plan for the patient for that day. After explaining to the doctors that the patient’s family member had a lot of concerns as far as plan, the prognosis, and exactly what is going on with the patient the doctor agreed for the patient’s family member to listen and to participate. Involving the patient’s family in these situations might be a helpful thing, sometimes families see black and white, as far as their family member getting better or getting worse that day. Involving the patient families allows them to hear every single thing that is either working with the patient or that is not working. This will also give the family the opportunity to ask any questions that they need to or have the physicians ask anything that they need to while there are multiple team members at the patient’s bedside. I will be using family centered care because it shows that as a provider, you actually care to listen and explain to the family and patients what is going on. The hospital is already a very confusing place with many ups and downs in an acute setting, and to have medical terminology being used with non-medical people adds a lot of stress with families (Cypress, 2012). In the ICU, there are many pieces of equipment hooked up to their family member and several alarms going off in the room, taking five minutes out of your time as a provider to sit down and explain what all of the machines do or any alarm will not only gain trust and rapport between you and the family member but will also allow their mind to rest easy  and ask any questions that may be concerning to them (Should Family Members, 2020). Cypress, B. (2012). Patient Preferences and Decision Making

Family presence on rounds: A systematic review of literature. Retrieved February 08, 2021, from https://www.nursingcenter.com/journalarticle?Article_ID=1278114&Journal_ID=54014&I ssue_ID=1277698 Should family members participate in icu rounds? (2020, December 02). Retrieved February 08, 2021, from https://www.aarc.org/nn18-family-members-in-icu/ My discussion so that Tutor read and see my idea to share with the 2 students Week #11 Discussion. Patient Preferences and Decision Making Patient involvement with treatment is considered a crucial aspect of patient-centered care and can contribute to improved care outcomes. In my work, I often strive to include patients in treatment and coach them to make informed decisions. A point of conflict in this process is usually when the patient makes decisions that are against the best outcomes of care. Patients have a right to autonomy in decision-making and practitioners should honor that right even when patients do not make the best treatment decisions according to healthcare practice (Kilbride & Joffe, 2018). On one instance, a patient presented at the hospital with obesity and preexisting diabetes and wanted a solution for weight loss. The patient had a BMI of 31 and wanted to receive medication prescriptions for weight loss. According to Healthwise (2020), prescriptions are appropriate if the patient has tried losing weight through lifestyle adjustments and failed. However, in the case of this patient, he had not made the necessary dietary and lifestyle changes. After involving them in discussing their options, the patient still insisted on medication-assisted weight loss. The physician had no option than to prescribe the medication and I educated the patient on necessary dietary and lifestyle adjustments. The impact of patient involvement in treatment is often positive with increased patient knowledge and health maintenance. Evidence also shows that patient satisfaction can be improved with their involvement in care (McAlpine et al., 2018). On the other hand, the instance I have discussed shows how involving patients in treatment, although beneficial, may lead to complexity of care. The patient’s right to make decisions about their care process may sometimes conflict with the best-practice care approaches. Overall, using patient decision aid is crucial in informing best practices because patients can compare options and make informed decisions. The decision aid website presents a brief discussion and comparison of different options including benefits and risks of each option (The Ottawa Hospital Research Institute, 2019). The website is thus important in enabling patients to make decisions based on credible information. Practitioners can also use the website to inform their practice and decision-making. Patient involvement in treatment enhances care outcomes and keeping patients informed ensures that best-practice strategies are implemented. I definitely I recommend The Ottawa to my patients. References Healthwise. (2020, Sept. 23). Obesity: Should I take weight-loss medicine? https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=aa7 1898 Kilbride, M. K., & Joffe, S. (2018). The new age of patient autonomy: Implications for the patient-physician relationship. Jama, 320(19), 1973-1974. https://doi.org/10.1001/jama.2018.14382 McAlpine, K., Lewis, K. B., Trevena, L. J., & Stacey, D. (2018). What is the effectiveness of patient decision aids for cancer-related decisions? A systematic review subanalysis. JCO Clinical Cancer Informatics, 2, 1-13. https://doi.org/10.1200/CCI.17.00148 The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/ See Rubric next page for grading detail Rubric Detail Name: Patient Preferences and Decision Making NURS_6052_Module06_Week11_Discussion_Rubric Exit • Excellent Main Posting 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Main Post: Timeliness 10 (10%) – 10 (10%) Posts main post by day 3. Excellent First Response 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Second Response 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. . Excellent Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Participation 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days. Total Points: 100 Name: NURS_6052_Module06_Week11_Discussion_Rubric Learning Resources Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/ 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). Patient Preferences and Decision Making

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 Note: You will access this article from the Walden Library databases. 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 Note: You will access this article from the Walden Library databases. 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 Note: You will access this article from the Walden Library databases. Continues next page 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 Note: You will access this article from the Walden Library databases. The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/ …Patient Preferences and Decision Making
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