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52/8 Discuss REPLY 2
Write a 2 Paragraph response (with 2-3 sources) 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. I posted 4 sources you can use them or whatever is easier for you
In order for best practice to occur, both evidenced-based decision making and shared decision making must be met (Melnyk & Fineout-Overholt, 2018). Both are dependent on one another (Hoffman, Montori, & Del Mar, 2014). The involvement of patients or their surrogates into decision making manifests respect for the individual and would coincide with a patient’s values, goals, and preferences thereby improving outcomes (Kon, Davidson, Morrison, & Danis, et. al., 2016). Cost-effectiveness analysis is an integral part of this process (Opperman, Liebig, & Bowling, 2016). Utilization of this approach must demonstrate value; the least expensive option yields the best outcomes (Opperman, Liebig, & Bowling, 2016).
Kon, Davidson, and Morrison, et. al., define SDM or shared decision making as ‘a collaborative process that allows patients or their surrogates and clinicians to make healthcare decisions together, taking into account the best scientific evidence overall, as well as the patient’s values, goals and preferences’ (Kon, Davidson, Morrison, & Danis, et. al., 2016). At Cooper University Hospital, Camden, NJ, there is a robust bariatric surgery program. Patients greenlighted for surgery must meet criteria that includes; active involvement in Cooper’s bariatric surgery education program, unchanged weight from diet and exercise, clearance by a psychiatrist, agreement to follow post-operative instructions, BMI > 35%, and diagnosis of at least 2 comorbidities such as diabetes, hypertension, sleep apnea, etc. Post-operative and inpatient orders are entered by physicians or APRNs as pathways. These pathways are surgery specific, based upon evidence-based practice, and do not deviate. These pathways are released starting in the pre-operative phase and subsequently released at each stage of the patient’s hospitalization. Several months ago, I recovered a 23-year-old female who underwent gastric sleeve surgery. Upon her arrival to PACU, she appeared anxious, was experiencing pain, and was refusing to comply with BIPAP in the acute phase of recovery. Even after both myself and her healthcare team attempted to reeducate her, allay her fears, reassess her preferences and values while meeting her current concerns she remained absolute in her refusal. She remained somnolent throughout recovery and required a longer post-operative recovery than usual. Her continued refusals delayed her admission to the floor, the initiation of her diet, and ambulating. According to her healthcare team, her attitude remained unchanged upon her arrival to the floor. Even after multiple attempts by the healthcare team to reassess her preferences, values, and concerns throughout her hospitalization she remained resolute in her treatment refusals despite being presented with best practice outcomes specific to her surgery. Her admission stay was extended several days to accommodate the postoperative complications she experienced. At some point in the process of clearing her for surgery, an important step was missed which left her feeling powerless post-operatively and led her to make decisions that adversely affected her care, surgical outcome, and increased the costs attached to it.
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