Discussion: Patient Preferences and Decision Making

**DEADLINE:

FRIDAY

5/13

/2021

BY

08:00

PM

EST**

INSTRUCTIONS:

Respon

d

to

your colleague

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

.

*

*

At least 2 references p

er reply, and they need to support information in the reply**

April

Almstead

In the ICU,

the patients are not often able to participate in their treatment plan due to the acuity of their

illness or being on a mechanical ventilator. In these situation, the patient's family or spouse is often

responsible for making decisions for them

until they are able to speak for themself.

One of the most common

decisions that patients' families have to make is regarding code status. As a patient's condition declines,

physicians sometimes have to discuss this with patients' families and inform the

m of the prognosis as well as

the process of CPR and ACLS.

Some patients that have been on a ventilator for a long period of time will need

to be given a tracheostomy

and a PEG tube in order to continue trying to recover. These are difficult decisions

to

make and families need to think about whether or not their loved one would want such things or would

prefer to be on hospice, or to have a "Do Not Resusitate" (DNR) order placed.

To give an example of this: I recently was called to a rapid response for a

patient that was in respiratory

distress.

When I got to her room, she was slumped over in the bed and working hard to breathe.

The

patient's nurse informed me that she was a full code, but that she had end stage lung cancer which had

metastisized to her

liver.

After reviewing her information and the oncologists notes, it was stated that if she

was to be put on a ventilator it would be very unlikely that she would ever be extubated, and she would not

likely survive for a significant amount of time. Given

the severity of the patients condition, and her difficulty

breathing, I decided to contact her daughter who was her health care decision maker. I told her the situation

and I asked her to come to the hospital and see her mother. When she arrived, I spoke w

ith her about the

possibility of her needing a ventilator and what that might mean for her. After careful thought her daughter

decided to make her mother a DNR and DNI (Do Not Intubate). She knew that her mother would not want to

have that done to her and

wanted us to provide as much comfort and peace for her mother as we could.

The "Understanding the Options" decision aid is very helpful for guiding patients and their families in making

tough decisions about end of life issues. It tells them about palliat

ive care, hospice, comfort care, and advance

directives (The Ottawa Hospital, 2015).

It is best to give this pamphlet to patients and their families early on

in their treatment, so that the family is not faced with these decisions under pressure or urgent

ly. It gives

them time to learn about what their options are

(Schroy, Mylvaganam, & Davidson, 2014)

and discuss what

the patients wishes are so that if they do have to make such decisions, they will be prepared.

The Ottawa Hospital. (2015). Understanding

your options: planning care for critically ill patients in the

Intensive Care Unit. Retrieved May 12, 2021

from

https://decisionaid.ohri.ca/docs/das/Critically_Ill_Decision_Support.pdf

Schroy,

P.

C.,

Mylvaganam,

S.,

&

Davidson,

P.

(2014).

Provider

perspec

tives

on

the

utility

of

a

colorectal

cancer

screening

decision

aid

for

facilitating

shared

decision

making.

Health

Expectation

s

,

1

7

(1),

27

–

35.

https://doi

-

org.ezp.waldenulibrary.org/10.1111/j.1369

-

7625.2011.00730.

x

**DEADLINE: FRIDAY 5/13/2021 BY 08:00 PM EST**

INSTRUCTIONS: Respond to your colleague 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.

**At least 2 references per reply, and they need to support information in the reply**

April Almstead

In the ICU, the patients are not often able to participate in their treatment plan due to the acuity of their

illness or being on a mechanical ventilator. In these situation, the patient's family or spouse is often

responsible for making decisions for them until they are able to speak for themself. One of the most common

decisions that patients' families have to make is regarding code status. As a patient's condition declines,

physicians sometimes have to discuss this with patients' families and inform them of the prognosis as well as

the process of CPR and ACLS. Some patients that have been on a ventilator for a long period of time will need

to be given a tracheostomy and a PEG tube in order to continue trying to recover. These are difficult decisions

to make and families need to think about whether or not their loved one would want such things or would

prefer to be on hospice, or to have a "Do Not Resusitate" (DNR) order placed.

To give an example of this: I recently was called to a rapid response for a patient that was in respiratory

distress. When I got to her room, she was slumped over in the bed and working hard to breathe. The

patient's nurse informed me that she was a full code, but that she had end stage lung cancer which had

metastisized to her liver. After reviewing her information and the oncologists notes, it was stated that if she

was to be put on a ventilator it would be very unlikely that she would ever be extubated, and she would not

likely survive for a significant amount of time. Given the severity of the patients condition, and her difficulty

breathing, I decided to contact her daughter who was her health care decision maker. I told her the situation

and I asked her to come to the hospital and see her mother. When she arrived, I spoke with her about the

possibility of her needing a ventilator and what that might mean for her. After careful thought her daughter

decided to make her mother a DNR and DNI (Do Not Intubate). She knew that her mother would not want to

have that done to her and wanted us to provide as much comfort and peace for her mother as we could.

The "Understanding the Options" decision aid is very helpful for guiding patients and their families in making

tough decisions about end of life issues. It tells them about palliative care, hospice, comfort care, and advance

directives (The Ottawa Hospital, 2015). It is best to give this pamphlet to patients and their families early on

in their treatment, so that the family is not faced with these decisions under pressure or urgently. It gives

them time to learn about what their options are (Schroy, Mylvaganam, & Davidson, 2014) and discuss what

the patients wishes are so that if they do have to make such decisions, they will be prepared.

The Ottawa Hospital. (2015). Understanding your options: planning care for critically ill patients in the

Intensive Care Unit. Retrieved May 12, 2021

from https://decisionaid.ohri.ca/docs/das/Critically_Ill_Decision_Support.pdf

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.

https://doi-org.ezp.waldenulibrary.org/10.1111/j.1369-7625.2011.00730.x