Discussion: Patient Preferences and Decision Making

Discussion: Patient Preferences and Decision Making

By Day 3 of Week 11

Share a brief description of the situation you encountered and clarify how taking into account or not taking into account patient preferences and values influenced the treatment plan’s results. Give specific examples. Then, elaborate on how considering patient preferences and values could change the course of the situation and how these considerations were reflected in the treatment plan. Lastly, explain the usefulness of the patient decision aid you picked and how it can contribute to effective decision making, both in general and in the scenario you mentioned. Explain how you might apply this decision aid inventory in your professional or personal life.

By Day 6 of Week 11

Engage with at least two peers on separate days and present different perspectives on how patient preferences can affect treatment plans or results, or the potential impact of patient decision aids on situations similar to the one shared.

Discussion – Week 11

A year ago, I cared for a COVID patient who also had liver cancer. Unfortunately, the prognosis was very grim because the cancer had spread throughout his body, including his brain. What made this situation unusual was that the patient didn’t know he had cancer. His family chose not to inform him and simply told him he was in bad shape because of COVID. The patient didn’t speak English, and the family would only translate what they wanted and sometimes even make things up. I know this because I speak Spanish, and as the doctor spoke, I translated, but the family would interrupt.

This situation posed an ethical dilemma. The doctor wanted to tell the patient what was happening and discuss medical options, but the family prevented it. Code status also needed to be addressed, but again, the family interfered.

It wasn’t until the family left to have a meal one day that the doctor could finally talk to the patient and inform him about his condition. The patient’s family loved him deeply, but they were doing a great injustice. The physician wanted to have a shared decision-making (SDM) discussion, a process where the doctor and patient talk about medical options, possible outcomes, potential complications, and the patient’s wishes. The patient was alert, oriented, coherent, and capable of making his own decisions. The family wanted him to fight through COVID first, and then they would tell him about the cancer. However, I honestly believe he didn’t survive for long. It’s difficult to witness a family going through such pain, but as healthcare professionals, we’ve sworn to protect our patients and do no harm. Patients who are more involved in their care, understand the consequences of each decision, and are willing to explore new treatments have better control over their health and experience less decision-making conflict.

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Eventually, the doctor and I were able to discuss code status with the patient, and he wanted to remain a full code. He was only 45 years old. Code status is a highly personal decision, and families often oppose “Do Not Resuscitate” (DNR) orders, which is why conversations between physicians and patients are crucial. The Ottawa Personal Decision Guide is a valuable tool for situations less severe than my patient’s. I will definitely recommend this tool to some of my patients who could benefit from this questionnaire and make decisions that best suit their circumstances.

Reference:

Driever, E. M., Stiggelbout, A. M., & Brand, P. L. P. (2022). Patients’ preferred, perceived decision-making roles, and observed patient involvement in videotaped encounters with medical specialists. Patient Education and Counseling. https://doi.org/10.1016/j.pec.2022.03.025

Hahlweg, P., Kriston, L., Scholl, I., Brähler, E., Faller, H., Schulz, H., Weis, J., Koch, U., Wegscheider, K., Mehnert, A., & Härter, M. (2020). Cancer patients’ preferred and perceived level of involvement in treatment decision-making: an epidemiological study. Acta Oncologica (Stockholm, Sweden), 59(8), 967–974. https://doi.org/10.1080/0284186X.2020.1762926

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