Respond to two of 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.
Peer 1
Apr 29, 2024Apr 29 at 10:46amManage Discussion Entry
Greetings class
For this week’s scenario, I am presenting a male, 31 y/o patient, married, with no kids, with recurrent visits to the ER complaining of LLQ abdominal pain and recurrent admission for diverticulitis. In this admission abdominal imaging studies showed a fistula compromising reproductive organs. An emergency colectomy was scheduled with a colostomy which is considered to be temporary and a future anastomosis to the remaining rectal portion. The infection was so widespread that internal reproductive organs needed to be removed and future offspring compromised. After surgery, the patient’s main complaint related to his reproductive dysfunction, and despite he reviewed and signed all consents related to the surgery options to maintain his reproductive function or procreative alternatives were never discussed. In this scenario, the clinicians started with a default approach and presented the patient with all the elements including information exchange, evaluation of alternatives, and a final decision (Kon et all, 2116), but failed to present a full scenario of additional and possible compromise of the reproductive system. The patient’s exact complaint was that in the options offered by the healthcare team sperm preservation for future spouse insemination was not presented (Borate & Meshram, 2022).
For this patient, the social and community context, one of the elements of the social determinants of health, and particularly the possibility of developing a family with his descendants, will have a major impact on his developmental role. The community’s support and his realization fathering his offspring will need to be diverted to different options challenging additional determinants such as economic stability and healthcare access (Burton, 2023).
References
Kon, A. A., M.D., Davidson, Judy E,D.N.P., R.N., Morrison, W., M.D., Danis, M., M.D., & White, Douglas B,M.D., M.A.S. (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), 1334-1336. https://www.proquest.com/scholarly-journals/shared-decision-making-intensive-care-units/docview/1797885427/se-2Links to an external site.
Borate, G. M., & Meshram, A. (2022). Cryopreservation of Sperm: A Review. Cureus. https://doi.org/10.7759/cureus.31402
Burton, K. (2023). Academic Guides: Social Determinants of Health: Social Determinants of Health. Academicguides.waldenu.edu. https://academicguides.waldenu.edu/Library/sdoh
Peer 2
WednesdayMay 1 at 1:40pmManage Discussion Entry
Main Post
The COVID-19 pandemic was devastating, and it exposed me to different patients who are presenting with diverse health concerns. I remember a patient who had COVID-19 and was later diagnosed with liver cancer. Throughout the care process, I realized that he had an extremely poor prognosis because the liver cancer had become metastatic. It was unfortunate that the patient was not initially aware of the cancer because his family members were withholding this information, and they were only willing to give information about COVID-19. The patient did not understand the English language, and the family members were translating; they only gave information about other diseases without giving comprehensive information to explain the situation. I consider the situation to be an ethical dilemma because, as a healthcare professional, part of my responsibility is to be transparent with the patient to communicate the disease and the available medical options. However, the family will not let me embrace this approach because of the fear of the effects of diversity on the patients.
However, one day, when the family members left, the doctor was capable of speaking with the patient and informed about all the health issues with the help of our translator. It was considered that such communication was part of a critical responsibility of the professional. The physician was interested in discussing shared decision-making approaches through processes in which there will be transparent and relevant communication to address the patient’s wishes without external interference (Hahlweg et al., 2020). The process of communicating shared decision-making was enabled by the effective incorporation of the Ottawa Personal Decision Guide. Through this awful and effective decision-making age, it was possible to ensure that the patient understood the existing situation and the repercussions or consequences of the health proposal that was provided (The Ottawa Hospital Research Institute, 2019).
The Ottawa Personal Decision Guide can only be effective if there is an understanding among the parties involved that they are willing to impose a reduction in the decision and accept the consequences. The willingness enables targeted ways of making information more accessible and transparent. It is also true that it helps with the protection of the interests and needs of the patient, especially in severe cases (The Ottawa Hospital Research Institute, 2019). I will recommend this to my current organization because it will enable an effective way of understanding the patient’s situation, encouraging the adoption of highly rational and relevant treatment plans that respect preferences while also incorporating quality solutions in the long term (Driever et al., 2022).
References
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/
