Treatment Preferences and Decision Making
Current models of healthcare emphasize the significance of including the values of patients in the decision-making process, especially decisions for which there exists minimal data that supports a clear strategy and choice of treatment. The construction of preferences for complex healthcare decisions necessitates that patients should take into account the numerous trade-offs between explicit benefits and risks. Evidence-based medicine and shared decision making are essential to the delivery of quality health care, but the interdependence between the two approaches is not appreciated. First, evidence-based medicine begins and ends with the patient. Clinicians attempt to make decisions that reflect the circumstances and values of the patient after the discovery and appraisal of the evidence and integration of inferences with expertise (Hoffman et al., 2014). Secondly, shared decision making is defined as the collaborative process, which allows clinicians, patients, or surrogates, to engage in care decision-making together, considering the best scientific evidence and the goals, values, and preferences of the patient (Kon et al., 2016). This is the connection of patient-centred communication and evidence-based medicine, in the peak of proper health care.
Some pharmacological treatment for metastatic colorectal cancer can have marginal survival benefits, but, they tend to cause toxicities. I recently encountered a patient with a diagnosis of advanced colorectal cancer who had completed a chemotherapy regimen. Consistent with evidence-based medicine and shared decision making approaches, I incorporated his values and preferences in the development of his treatment plan (Melnyk & Fineout-Overholt, 2018). First, I asked him to rank the significance of 10 adverse events of the pharmacological treatment, which might arise due to the biological and chemotherapy therapy as the treatment decisions. Next, the patient identified his five most significant events and preferences in hypothetical treatment plan vignettes based on the standard gambling method. The patient identified stroke, gastrointestinal perforation, and heart attack as the most significant adverse events in his treatment decision-making. However, he expressed lesser readiness for tolerating events related to symptoms such as depression, pain, and fatigue. In this situation, the metastatic CRC trade-offs of the patient were incorporated into the personalized decision to undertake and adhere to the new medical treatment.
Health Condition: Colorectal Cancer
According to the Ottawa Hospital Research Institute, the patient decision aids for colorectal cancer (CRC) is the screening test for persons aged 50 and above who has normal risks for colon cancer. The options included in the decision aid are stool tests, like FOBT stool tests at the recommended sigmoidoscopy and tome, and colonoscopy, every one year, five years, ten years respectively. Decision aids for CRC screening have proven to allow patients to ascertain their preferred screening options, but the degree to which the tools expedite shared decision making from the providers’ perspective of is less well established. Researchers revealed the above 60% of the primary care providers who took part in a clinical trial felt that using the tool complimented their approach. It increased knowledge among the patient, helped them identify the preferred screening options, saved time, enhanced the decision making quality, and augmented their desire to undergo screening (Schroy, et al., 2014). Therefore, the decision aids for colorectal cancer screening can enhance the efficiency and quality of shared decision making from the providers’ perspective; however, the future use is dependent on the degree to which implementation barriers are addressed effectively.
References
Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186.
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice: Wolters Kluwer.
Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/AZsumm.php?ID=1192
Schroy, 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), 27–35. doi:10.1111/j.1369-7625.2011.00730.x