Shared Decision-Making

Some patients may wish to be actively included in discussing treatment options, while
others would want to rely on their physicians to decide for them. Most patients have
information about their health needs and the best course of treatment they would prefer.
Additionally, some caregivers, such as family members with the power of attorney or
significant beneficiaries of the patients, might adhere to specific cultures that regulate how they
would prefer the treatment options and clinical decisions to be made (Charles et al., 1997) . This
calls for shared decision-making, which refers to a situation where a health professional and the
patient or the patient’s caregivers work together in making decisions and select tests, treatments
and care plans based on clinical evidence that balances risks and expected outcomes with
patient preferences and value (Baliski & Hamm, 2020) . However, before making these clinical
decisions, the physician is required to provide full information to the patient to enable them to
explore treatment options alongside their risks and benefits thoroughly.
In my workplace, elective surgery is a commonplace practice since most patients have
sufficient health information and often visit their health care providers in time for assessments.
My experience where a patient was involved in decision making of her treatment options was
when we had to schedule a patient for bariatric gastric bypass surgery. The patient was an obese
14-year old. Her mother is a nurse and was well versed in the treatment options. Since most
elective surgeries, especially for bariatric surgeries, are preference-sensitive care, the family
had to be informed about the treatment options and given sufficient time before they could
decide on the best option available. My role as a nurse in a multidisciplinary team was to
conduct patient and caregiver education, assist in the shared decision-making process, and
implement the agreed treatment plan (Turnbull et al., 2018) .

Including patient preferences and values in treatment planning, in this case, was crucial
in deciding to conduct an adjustable gastric banding, also called lap band surgery, and planning
for an appropriate date for the surgery based on the patient’s preference.
Decision aids are essential tools since they assist physicians with a comprehensive,
understandable review of the patient’s conditions as well as treatment options. Additionally, the
tool helps the patient in thinking about how the treatment option would fit into their holistic
lifestyle needs and preferences. The selected decision aid is the one used to decide if you should
stay in your retirement/assisted living home or go to live elsewhere. This tool examines the
preparedness of the patient and their environment to deal with their needs and preferences. It is
also relevant to my case because it could help in scheduling for the surgery when the patient
could receive the best care, both in the hospital and after discharge.

References

Baliski, C., & Hamm, J. (2020). Does receipt of preference sensitive care impact patient
reported outcomes following breast cancer surgery? American Journal of Surgery,
219(5), 746–749. https://doi.org/10.1016/j.amjsurg.2020.02.060
Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter:
What does it mean? (Or it takes, at least two to tango). Social Science and Medicine,
44(5), 681–692. https://doi.org/10.1016/S0277-9536(96)00221-3
Turnbull, A. E., Sahetya, S. K., Colantuoni, E., Kweku, J., Nikooie, R., & Curtis, J. R. (2018).
Inter-Rater Agreement of Intensivists Evaluating the Goal Concordance of Preference-
Sensitive ICU Interventions. Journal of Pain and Symptom Management, 56(3), 406-
413.e3. https://doi.org/10.1016/j.jpainsymman.2018.06.003