response 1
PATIENT PREFERENCES AND DECISION MAKINGA situation arose where a patient’s treatment plan did not consider her preferences or values, specifically in relation to her religious beliefs. Upon admission to our inpatient mental health hospital, a female patient was required to remove her head covering for safety reasons, without adequate explanation. This caused distress for the patient, and her husband raised the issue after their first phone call. Subsequently, the staff apologized, clarified the safety reasons behind the process, and allowed her to resume wearing her head covering. Despite the resolution, the incident damaged the patient’s trust in the hospital, impacting her perception of its competence. The importance of incorporating patient preferences, particularly related to religious beliefs, was evident in this case, as overlooking them could have led to potential gaps in her treatment and care (Mentzelopoulos et al., 2021).Incorporating patient preferences is crucial for building rapport and trust. Despite the challenges in a mental health hospital setting, treating patients with dignity and respect includes accommodating their religious needs and preferences (LeDoux et al., 2019). This is significant in combating the stigma associated with mental health. Patients seeking mental health treatment already face societal judgment, and it is essential that they feel accepted during their treatment journey. Ensuring the inclusion of patient values and preferences in the treatment plan is a vital aspect of fostering a supportive and accepting environment.In this specific case, accommodating the patient’s religious beliefs facilitated effective decision-making. By addressing her concerns about maintaining her religious practices during hospitalization, the patient could focus on the necessary treatment without unnecessary distractions. Overall, considering patient preferences and values in the treatment plan enhances compliance, as patients feel valued and respected. Research suggests that patient values play a role in treatment compliance and outcomes, highlighting the importance of involving patients in the decision-making process.The decision aid inventory mentioned in the text could be a valuable tool in both professional and personal settings (Scalia et al., 2019). Utilizing it in patient care and personal interactions, especially when providing advice as a nurse, aligns with the goal of involving individuals in decision-making. Patient decision aids serve to make decisions explicit, provide information about options and outcomes, and clarify personal values. Integrating such tools can empower patients, enabling them to better understand their experiences and make informed decisions about their treatment and care.ReferencesLeDoux, J., Mann, C., Demoratz, M., & Young, J. (2019). Addressing Spiritual and Religious Influences in Care Delivery. Professional Case Management, 24(3), 142147. https://doi.org/10.1097/ncm.0000000000000346Mentzelopoulos, S. D., Couper, K., Voorde, P. V. de, Druwé, P., Blom, M., Perkins, G. D., Lulic, I., Djakow, J., Raffay, V., Lilja, G., & Bossaert, L. (2021). European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions. Resuscitation, 161, 408432. https://doi.org/10.1016/j.resuscitation.2021.02.017Scalia, P., Durand, M.-A., Faber, M., Kremer, J. A., Song, J., & Elwyn, G. (2019). User-testing an interactive option grid decision aid for prostate cancer screening: lessons to improve usability. BMJ Open, 9(5), e026748. https://doi.org/10.1136/bmjopen-2018-026748 ReplyReply to Commen
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Response 2
Patient Preferences and Decision-Making
Working with patients with kidney failure undergoing dialysis exposes me to a great deal of people with different social determinants of health. While some may have acute renal failure from accidental cases, most patients who end up with dialysis start with diabetes or hypertension, resulting in gradual and progressive deterioration of kidney health. The prognosis of their disease treatment depends on the decision they make. Also, these decisions are caused due to their health values, goals, and preferences. Clinicians need to understand the patient’s values, goals, and preferences to avoid patients feeling excluded from their health decision-making (Kon et al., 2016).The patient in this scenario is a 67-year-old female African/American with a diagnosis of end-stage kidney failure undergoing dialysis. The patient’s treatment decision is three times weekly hemodialysis. The patient was not able to attend dialysis as prescribed. She only comes once a week. When she was contacted, the patient reported being homeless and squatting with a relative who goes to work and can only make time once a week to bring her to the clinic. The patient also reported being unemployed with limited income from social security. She says that the money from social security serves to feed her alone. Hence, her only choice is to come to the clinic once a week. Anytime the patient comes to the clinic, she has critical lab values, swollen feet, and puffy eyes. Her dialysis session lasts between 3 to 4 hours due to the level of fluid retention.Using the decision aid “My Choice for My Kidneys” (Ottawa Hospital Research Institute, 2019), the patient was educated on different forms of dialysis: continuous ambulatory peritoneal dialysis (CAPD), Automated Peritoneal Dialysis (APD), and hemodialysis (HD) were presented as her choices Based on her lack of transportation and limited income, she chose peritoneal dialysis. (CAPD) has its positive and negative implications. Patients undergoing peritoneal dialysis need a clean and spacious environment. However, based on the patient’s social issues and the possibility of infection, it was determined impossible for the patient. The patient has the right to make her health decisions. However, if the clinician decides to go by the patient’s decision, she will die either from heart failure related to fluid overload or septicemia from infection. The patient was provided with a social worker and case manager. The Medicare application was completed, and approval was received; hence, the patient now has Medicaid transportation to the clinic three days weekly as supposed.The patient’s decision for this treatment cannot be overlooked because it is being made based on her social and economic issues. Nevertheless, while the patient has the right to make her own decisions, working with the patient for positive outcomes and better treatment choices is essential. Decision aid tools empower patients to make informed decisions aligned with their values regarding a specific course of action, considering potential benefits, risks, probabilities, and scientific uncertainties. Decision aids enhance shared decision-making (SDM) by improving the quality and effectiveness of patient-provider interactions and empowering users to engage in decision-making actively (Schroy et al., 2014). The use of decision aids helps clinicians to understand the patient’s emotional, physical, and psychological strengths and needs. Using decision aids can indeed help individuals feel more knowledgeable, better informed, and more transparent about their values. They may also take a more active role in decision-making and have more accurate perceptions of risks (Stacey et al., 2017). Clinicians can use decision aids to gain insight into the patient’s social determinants of health and find a way to help alleviate the patient’s needs by exposing the patient to unknown available healthcare aids. ReferencesKon, A. A., Davidson, J. E, Morrison, W., Danis, M., & White, Douglas B. B. (2016). Shared Decision-Making in Intensive Care Units: Executive Summary of the American College of Critical Care Medicine and American Thoracic Society Policy Statement. American Journal of Respiratory and Critical Care Medicine, 193(12), 13341336. https://www.proquest.com/scholarly-journals/shared-decision-making-intensive-care-units/docview/1797885427/se-2Schroy, 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), 2735. doi:10.1111/j.1369-7625.2011.00730Stacey, D., Légaré, F., Lewis, K., Barry, M. J., Bennett, C. L., Eden, K. B., Holmes-Rovner, M., Llewellyn-Thomas, H., Lyddiatt, A., Thomson, R., & Trevena, L. (2017). Decision aids for people facing health treatment or screening decisions. The Cochrane database of systematic reviews, 4(4), CD001431. https://doi.org/10.1002/14651858.CD001431.pub5The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/. Reply
