Respond to your colleagues 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
At least 2 references in each peer responses!
In my experience patient centeredness has always been an important aspect of healthcare. Melnyk and fineout-overholt (2018) define patient centeredness as the required integration of patient preferences and values into evidence-based decision making. With the modern technology available today, patients are more informed than ever and more capable than ever to be involved in the decision-making process. One experience that I recently encountered was a patient making decisions about end of life care. The patient was suffering from ALS, and initially elected to have life extending procedures performed. The patient stated a desire to see his daughter get married and wanted to live several more months in order to be present at the wedding. This was important to him, and to abide by the patients wishes, the patient was trached, placed on a ventilator, and received a PEG tube. After educating the family and setting up a home healthcare plan the patient was sent home. Several months later, the patient returned, and as previously indicated, wanted all care discontinued. Personally, I have been involved in multiple end of life scenarios where treatment is withdrawn, but this situation was different from most. The patient was to the point in his disease process where he had severe physical limitation, but was fully alert and able to communicate. It was a foregone conclusion that as soon as the ventilator was removed, the patient would not have the strength to take an effective breath, but the patient and family were clear they did not want to continue care given the patients quality of life. This was a difficult case to be a part of, but looking back, I believe all the correct decisions were made.
Effect of Patients Values
This scenario created multiple questions, that depending on individual values, had different answers. The first question is the appropriateness of artificially extending life in a disease that leads to such a poor quality of life. Second, many were uncomfortable on removing the source of oxygen on a patient whose life could be extended by keeping the ventilator. In the Ottawa Hospital decision aid tool (2019), one of the primary questions that it recommends the patient answer, is the consideration of personal goals still wanted to achieve. In this case the patient made it clear, he wanted to attend his daughter’s wedding that was several months away, and as the decision aid tool recommends, this is a good reason to extend one’s life. Everyone has different things they prioritize as important, and this was the most important event left for the patient to do. To accommodate the patient’s wishes, the treatment plan was modified to ensure the patient could accomplish this final goal.
Value of the Patient Decision Aid
Evidence based medicine combined with shared decision making are critical factors in the overall quality of the healthcare system (Hoffmann, Montori, & Mar, 2014). To provide quality care the patient must be informed of all options, as well as the risk and benefit of decision making. The decision aid tool is very effective in walking the patient through all considerations to making decisions. The tool also provides the necessary education to make an informed decision. This tool would be an excellent tool to prepare a patient for a discussion about plan of care. When a patient is not informed about their disease process, the patient has little opportunity to ask the right questions, or make an informed decision. Often, agreeing with the treating physicians plan of care is the only option the patient feels like they have.
Personal Use of Tool
Prior to this course I wasn’t aware that tools were available in the patient decision making process. Going forward, I would recommend this tool to anyone who is facing a new plan of care. A patient should be informed of treatment options prior to making the final decision. This ensures tool ensures that a patient understands the process, all the options, and the right questions to ask. Ultimately, this will help the patient make a fully informed decision about personal healthcare.
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