Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences 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.

Last year I took care of a covid patient that also had liver cancer. His prognosis was extremely poor due to the patient also having metastatic liver cancer. This patient had it all over his body including his brain. The peculiar thing was that the patient did not know that he had cancer. The family refused to tell him that he had cancer and just told him that he was in bad shape because of covid. The patient did not speak English and the family would only translate what they wanted and, in some cases, make up things. I know because I speak Spanish and as the doctor would speak and I translate, they would stop me, and they would translate. This situation was an ethical dilemma because the doctor wanted to tell the patient what was going on and discuss medical options, but the family would not let him. Code status also needed to be addressed but again the family interrupted.

          It was not until the family left to eat one day that the doctor was able to speak with the patient and informed him everything that was going on. My patients family loved him so much, but they were committing a huge injustice. The physician wanted to discuss shared decision making (SDM), a process where the doctor and patient discuss medical options, possible outcomes, things that can go wrong, and the patients wishes (Driever et al., 2022). The patient was alert, oriented, coherent, and capable of making his own decisions. The family wanted him to fight through covid and then they would tell him he had cancer, but I honestly believe he did not make it too long. It is hard to see family go through such horrible pain but as healthcare professionals, we have sworn to protect our patients and cause no harm. Patients that are more involved in their care, know the consequences of each decision, and are boldly willing to try new treatments are in better control of their health and go through less decision-making conflict (Hahlweg et al., 2020).

          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 such a personal decision and family is usually against DNR orders, but that is why physician and patient conversations are vital. The Ottawa personal decision guide is a great tool for situations that are not as severe as my patients situation. I will certainly be recommending this tool to some of my patients who would benefit from this questionnaire and make the decision that best fits their situation.

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/