Class Responses
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.
Response 1
I currently work in an orthopedic unit in a small hospital. One of the things we see regularly is patients with post-operative infections. Recently I had a patient that had her knee replaced around seven weeks previously and had a small area that was still draining and not healing. When she went into the office to have it checked they sent her over to be admitted on my unit. They then opened her knee back up, cultured the surgical site, and washed the knee out. The patient was then started on antibiotics while we waited for cultures. After a few days the deep cultures from the surgical site remained negative and only the superficial cultures from the non-healing draining site were growing any bacteria. It was now time for the patient to decide about treatment. The orthopedic surgeon gave her the choice of doing a poly exchange or removing the hardware and replacing it temporarily with a spacer. The patient was given all the pros and cons of both procedures. This is the time we need to ensure adequate support is provided to the patient (Kon, 2016). Our job at this point is to make sure if there are any questions the patient has, we are available to answer them or get them the answers they need. We had also brought infectious disease in as a resource for the patient. It is important to understand the patient’s values, goals, and preferences at this point to help them make the decision that is best for them (Kon, 2016). In the end she decided to do the poly exchange, mobility was very important for her after surgery. The results of the poly exchange were promising at the time of discharge. Follow-up with the patient will continue to be needed.
The Ottawa Hospital Research Institute’s Decision Aids Inventory provides multiple guides that could help guide patients with decision making. I think the one that would work best for my patient is the Ottawa Personal Decision Guide (Ottawa, n.d.). This guide makes it easy to list the multiple options and the pros and cons for each option. Sometime filling out these guides and having the choices on paper to see makes the decisions clearer.
Some social determinants that may need to be considered when helping a patient make shared decision are economic stability, education, health care access, and environment (OASH, n.d). Education, including healthcare literacy, are very important things to consider when helping a patient make shared decisions. Ensuring that patients understand the information they are given about each option is crucial for ensuring their decisions match their values and goals. Ensuring that patients have access to the healthcare they will need for any follow up and the economic stability to meet their healthcare needs should always be a priority.
References
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 statementLinks to an external site. Links to an external site. . Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396
Office of Disease Prevention and Health Promotion (OASH). (n.d.) Social determinants of health. retrieved from https://health.gov
Ottawa Hospital Research Institute. Patient decision aids: Evaluation measures. Available at: https://decisionaid.ohri.ca/eval.html Links to an external site.
Response 2
Patient Shared Decision Making
In my current position, clients work with their care coordinators to develop their treatment plan problems, goals and objectives. The social determinants of health, including economic stability, education, healthcare, environment and community are included in the treatment plan considerations. These determinants help to shape healthcare for each patient and determine potential pathways and effects of treatment (Braveman & Gottlieb, 2014). Including these factors in the client’s treatment plan and allowing them to participate and determine what they would like to accomplish allows for an all-encompassing approach to their care that considers all dimensions.
The field that I work in is substance abuse and the clients are seen in their home environment. Clients create their initial treatment plan when working with their care coordinator on their first visit. They are asked to identify different problems related to their substance use to include in their treatment plan that involve the social determinants of health. These problems can indicate how their substance use has affected them financially, the status of their physical health, the environment that they are in, and whether or not they have a community to support them in their sobriety. The clients then determine the goals that they would like to accomplish to address each problem, as well as interventions to work on with their care team. Allowing the patients to have this input in their treatment plan demonstrates shared decision making and incorporates their own values and preferences to encourage adherence (Hoffmann, Montori & Del Mar, 2014). As discussed by James, patient participation in healthcare decision making typically results in better outcomes and potentially lower costs (2013)
The decision making tool that I think would most benefit my clients in this situation is the Ottawa Personal Decision Guide. This decision making tool allows the client the benefits of their sobriety and how much it actually means to them to make this lifestyle change. Additionally, it allows clients to determine if there are any disadvantages to getting sober. These listed disadvantages could also be utilized by the team as things to work on with the client, or as a framework for the problems of their treatment plan. The client is also able to determine their supports and values within the tool. Overall, I think that this decision tool could be beneficial in many circumstances but definitely also for clients with a substance use disorder (Ottawa Hospital Research Institute, n.d.).
References
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it’s time to consider the causes of the causes. Public health reports (Washington, D.C. : 1974), 129 Suppl 2(Suppl 2), 19–31. https://doi.org/10.1177/00333549141291S206 Links to an external site.
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. https://doi.org/10.1001/jama.2014.10186 Links to an external site.
James, J. (2013). Patient Engagement. Health Affairs Health Policy Brief. DOI: 10.1377/hpb20130214.898775
Ottawa Hospital Research Institute. Patient decision aids: Evaluation measures. Available at: https://decisionaid.ohri.ca/eval.html Links to an external site. .
