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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?

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.

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/Links to an external site..
Choose "For Specific Conditions," then Browse an alphabetical listing of decision aids by health topic.
After you have chosen a topic (or condition) and a decision aid, consider if social determinants of healthLinks to an external site. were considered in the treatment plan Social determinants of health can affect a patient's decision as these are conditions in the patient's environment, such as economic stability, education access, health care access and quality, neighborhood, and social and community context.
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.
BY DAY 3 OF WEEK 11
Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences, social determinants of healthLinks to an external site., and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences, social determinants of health, 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.

Sample Answer

The Situation: Lack of Patient Involvement and Social Determinants of Health

My experience centers on a patient I will call Mr. Elias, a retired individual in his late 60s with a complex, chronic condition: newly diagnosed severe, chronic kidney disease (CKD) requiring urgent lifestyle changes and pre-dialysis planning.

The Initial Treatment Plan: The medical team was excellent from a purely clinical standpoint, providing the evidence-based "best practice" recommendation: an extremely low-sodium, low-potassium, and low-protein diet, a multi-drug regimen to control blood pressure and phosphate levels, and a detailed schedule for weekly lab draws and bi-weekly specialist appointments. The patient was given a stack of printed materials and asked if he "understood" the severity of the situation and the plan. He nodded and agreed.

The Impact of Lack of Involvement/SDOH: Unfortunately, the patient returned to the clinic three months later with significantly worsened lab values and rapidly declining health. The team reviewed the chart and noted "non-adherence."

The critical failure here was the complete disregard for Social Determinants of Health (SDOH) and the patient's individual preferences:

Economic Stability/Food Insecurity (SDOH): Mr. Elias lived on a very fixed, low income. The prescribed diet required specific, often expensive, fresh produce, low-sodium prepared foods, and high-quality protein, which were unaffordable. He also lived in a food desert (Neighborhood), where access to quality grocery stores required two bus transfers, which was physically taxing and time-consuming.

Education Access/Literacy: Mr. Elias had low health literacy. While he could read, the dense, technical medical handouts overwhelmed him. He felt too ashamed to admit he didn't truly grasp the difference between potassium and phosphate or the complexities of the drug interactions.

Social Context/Community: He was recently widowed and isolated. His adherence was managed by his late wife, and he had no one to help prepare meals or remind him of his complex drug schedule, making the plan practically impossible to execute alone.