How To Decide? Navigating Patient Choices In Health Care

Spiral of Hands - LostintheredwoodsBlog post by Joe Babaian

A good decision is based on knowledge and not on numbers. – PLATO

We’ve all been there – whether as a patient, a physician, a nurse, or an advocate – how do we make the right choice when faced with an important health care decision impacting ourselves or the person we are caring for? In this era of advanced medicine, complex healthcare systems, #BigData and #DigitalHealth, the choices for any given concern are rarely limited to one or two.

What sources should inform the decision-making process? Can we rely on massive amounts of aggregated data including the best analysis our experts can produce? Do we rely on the human connection in health care, the incredible depth of systematic knowledge that our best clinicians and health professionals tap? What about the holistic view of patient needs including their feelings, circumstances, and environment – how does this factor into choosing what’s best?

The good news is that Plato, even after 2300+ years, was right – he didn’t mean that numbers (data) were useless, but he called for the use of knowledge that is informed by data, education, circumstances, and all the factors that constitute understanding.

A recent study by Dr. Saul Weiner (University of Illinois – Chicago) and his colleagues looked closely Patient-Centered Decision Making (PCDM). The study argued for the association between the contextualizing patient care and outcomes. Dr. Weiner and his peers stated:

We found that when physicians take into account the needs and circumstances (that is, context) of their patients when planning their care, individualized health care outcomes improve.

In fact, the study posits that answering this question is what matters most: “What is the best next thing for this patient at this time?” Powerfully, the researchers conclude:

Our findings suggest that when clinicians successfully answer the question, as reflected in their care plan, there is an associated benefit to the patient that is measurable and substantial.

The discussion of alternatives in health care decisions is always a hot topic. How do we know what’s best for the patient? A key part of any shared decision-making process is having all the options presented in advance. A coherent patient that’s well-informed and able to communicate is a great opportunity for a discussion. What about at-risk patients without the ability to comprehend, understand, and process the options (if given)?

A study by Dr. Floyd Fowler (senior research fellow at the Center for Survey Research at the University of Massachusetts Boston) helps frame the need for a more holistic approach to decision making:

The core of a good decision-making process is to know what the options are, hear the pros and cons, and that someone should ask you what you think. (emphasis mine)

Please join us on Tuesday, October 7, 2014 at 8:30pm Eastern (for your local time click here) as we discuss the following topics:

  • T1: What do you feel are the most important factors affecting a major health care decision? Which factors are less important?
  • T2: Is it ever OK to withhold options or information that you passionately feel could adversely affect the decision-making process? Examples?
  • T3: How have challenging decision-making situations personally impacted you as a patient or health care professional?
  • T4: What can we, as healthcare leaders, do to successfully improve the decision-making process for patients in such a way to improve their outcomes and associated overall experience (even if the outcomes aren’t ideal)?

Resources

Fowler, Floyd J, Jr, et al. “Decision-Making Process Reported By Medicare Patients Who Had Coronary Artery Stenting Or Surgery For Prostate Cancer.” Journal Of General Internal Medicine 27.8 (2012): 911-916. MEDLINE. Web. 4 Oct. 2014. http://www.ncbi.nlm.nih.gov/pubmed/22370767, accessed October 3 2014

Hobson, Katherine. “Surgical Patients Not Getting Information on Alternatives.” Health Blog. The Wall Street Journal, 2 Mar. 2012. Web. 4 Oct. 2014. http://blogs.wsj.com/health/2012/03/02/surgical-patients-not-getting-information-on-alternatives/, accessed October 3 2014

Weiner, Saul J, et al. “Patient-Centered Decision Making And Health Care Outcomes: An Observational Study.” Annals Of Internal Medicine 158.8 (2013): 573-579. MEDLINE. Web. 4 Oct. 2014. http://annals.org/article.aspx?articleid=1676452, accessed October 3 2014

Image Credit

Spiral of Hands – Lostintheredwoods

http://flic.kr/p/4YJRV3

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One comment

  1. Reblogged this on HealthcareVistas – by Joseph Babaian and commented:

    This week’s #hcldr blog is all about how patients and health care professionals make the truely right, best choices when it comes to major medical decisions. Read more about it and join me, along with Colin Hung, Bernadette Keefe MD, and the entire #hcldr community to discuss, engage, and learn this Tuesday, 10/7, 830p E for a chat.

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