How can you help a patient make a difficult treatment decision?

Actively trying to understand the patient's decision is a show of empathy and it fosters trust which in turn gets the patient to share the factors that influence the decision. Understanding helps to support patients in making choices that align with their personal values and life goals. This approach goes beyond just clarifying the medical details, enabling a deeper understanding of the patient's unique circumstances and needs.

Always keep in mind patients are information overloaded and overwhelmed. They feel like they’ve been caught up in a whirlwind and everything is out of their control. We use words they’ve never heard of before so keep the information as simple and as focused as possible. Use patient appropriate teaching tools, such as visual aides, as needed to help them understand. Then give them time to download the information before making a decision. Once a decision is made it is our responsibility to support that decision and provide the necessary resources. Giving a patient back some of the control lost with a cancer diagnosis is just as important psychosocially as their medical treatment.

Understanding your pt and their goal & values is **key** in medical decision-making because it ensures that the care provided aligns with what matters most to the patient. This personalized approach not only respects the patient's autonomy and preferences but also enhances the effectiveness of care by addressing the individual's specific health needs + concerns. Theoretically, this should lead to improved outcomes. :)

In shared decision making, especially when it is complex, certain elements may be crucial. It can be very helpful to share experiences with peers who have been through the same situation. It helps to address what only those who have lived through it can really know: the experience of living with a disease or treatment in all its dimensions. The patient experience can also be approached from the perspective of studies that measure and analyse it. These studies have the advantage of providing a global vision.

I agree. experience has shown me that every patient is individual in thinking .Some may need more time and support to make important treatment decisions.Time should be allowed for that. You may need to advocate for the individual dependant on their ability or level of understanding. Respecting individual choices is paramount. Sometimes, a persons choices re treatment options may not align with your beliefs and values so being non judgmental and accepting of others perspectives will make sure they can make an individual decision.

It is important to help the patient get to the heart of what is truly important to them, as they consider pursuing treatment. Reviewing topics such as goals, finances, short and long term treatment expectations, level of family or community support, and concerns about the recovery period, can help the patient to first focus on their unique desires for wanting to pursue treatment. It is important to allow the patient the time and space to process quietly and audibly, as they think through the "what ifs" and the "maybes." Practicing active listening while walking a patient through this reflective exercise is valuable. Validating the patient's concerns and mixture of emotions, while showing empathy and compassion, is also helpful.

Exploring patients’ values, concerns, and goals will ensure a more personalized and patient-centered approach to care. It’s important to acknowlegde that people have different needs .

One thing that is tremendously helpful is encouraging the person to bring a friend or family member along to the appointment. It can be difficult to take in all the information when a new diagnosis or treatment plan is discussed. In addition, providing printed material at the end of the appointment can help the patient stay on track for follow up if needed.

In my experience, patients are not likely to feel at peace with a decision unless they come to it on their own. My job as a nurse has never been to tell a patient or family what to do, but to guide them to the decisions that must be made. I do this through active listening and asking thoughtful, directed questions that are unique to the patients’ situation. I have found more often than not that people know what decisions need to be made (for example, end-of-life planning) - but they’re scared to make them without validation that said decisions are okay. Listening and responding in kind with accurate information that reflects the truth of a situation usually is enough to help a conflicted patient or family make the tough decisions.

If there are other factors at play such as coercion or fear or depression it is important to assist them in making their own decision and not someone elses. Make them feel safe to do that. If they need some extra help with emotions make sure they are able to gain that help if they so desire. None of us should make decisions when we are fearful or being pushed or depressed. We need to make decision as our best selves as so in advocating we need to try to facilitate that safe environment and hold space for them to explore those emotions and find their way.

I’ve found it helpful to really know what the patients are dealing with completely before you can help them make decisions. Sometimes they are big decisions and we only see them for a snapshot of time. We have to rely on their perspective to make the decisions that are best for them.

Being realistic about the plan can be hard. Talking is easy, but the action plan has to be honest and realistic. All barriers should be openly discussed and considered.

Evaluating the evidence is key for patients comparing options. As a provider, we should guide patients to review evidence-based sources when making a decision. It would also be beneficial to understand the patient’s learning needs: are they a visual learner, a reader, or would the like to hold conversations. If desired, we can also guide patients to organizational-led support groups so they can socialize with others who are facing similar situations.

Evaluating the options is important Calmly explain the advantage and disadvantages associated with their preferences Help them understand what they are getting into Give them other alternatives with their (advantages and disadvantages too) Don’t force any idea on them, just empathize with them You’re called their healthCARE provider for a reason

I have always been partial to the pro and con list. Having the consequences of the choice in question written in front of you makes the decision more tangible.

A co-creation approach where the provider and the patient are both involved (actively) in creating a plan for treatment/care has proven to be effective in my experience as a physician. This collaborative process empowers the patient, fostering a sense of ownership over their healthcare journey. Also, continually reassure them that their decisions can evolve as their circumstances or preferences change, promoting a dynamic, patient-centered care approach.

Also consider what their fears and knowledge base of the diagnosis, possible outcomes, treatments and side effects in order to thoroughly complete a treatment plan which would include collaboratively treating the person and not just the disease.

Having a plan often helps to alleviate anxiety for the patient. It is important to have a collaborative approach where the patient and providers are involved. The plan should be in language that the patient can understand and relay to their support system as well.

I always try to say, “with what we have both learned today, what would you like to do next?” Repeat exactly what they say or make a few suggestions and then explain back to them what they chose. State this will be our plan and make it a SMART goal if possible.

In my practice, the multidisciplinary conference, attended by nurses, treating physicians, social worker, clergy (if desired), case managers, and others, sitting around a table with the parents, provides an effective method for summary of options and making a plan. This provides the parents with full access to those they trust and an opportunity to clarify their ongoing questions. Most feel supported with this format, however, a group discussion does not work for all.

Beyond the immediate decision-making juncture, I emphasize the importance of follow-up and ongoing support. This involves monitoring patient progress, addressing concerns that may arise post-treatment, and providing a continuous support system. A commitment to patient care extends beyond the transactional nature of decision-making, creating a relationship that spans the entirety of their healthcare journey.

Following up with a patient shows that the provider truly cares. It can help patients foster trust in the relationship. It’s helpful for the patient to have ongoing support and the ability to ask further questions about the healing process and/or other referrals if necessary. I have heard patients who have been very upset that their provider never followed up with them after what they consider to be life altering decisions and this really damaged the relationship and cause the patient to seek a new provider.

I agree very much with the information presented here and also contributed. It truly is important to follow back up on this, not just once but on a consistent basis. Experience and time certainly may put the initial decision into a different perspective later. It is important to be a supportive and active listener, but to also keep the follow-up happening. For example, when working with patients and families who may have gone the route of a major life altering surgery, time and other measures may be needed to make sure the immediate mental health care aspect is appropriately addressed as well.

Providing emotional support and active follow-up during their child’s treatment is absolutely mandatory for the parents’ healthy adjustment to hospital care, even palliative care. During a time when parents feel most alone and isolated, your support as their treating physician bolsters their well-being. It speaks volumes to parents when their physician reminds them that they have made difficult decisions and are doing what is best for their child.

It is critical to follow up with a patient after a major health decision. They could be having a downstream issue that would have been easily overlooked. For example if a patient has new home oxygen, they may be struggling with their mental health due to loss or independence or having to relay on the oxygen. Following up with them let's them know that they are not alone and as members of their care team we are there to help.

The best way to support a patient as a nurse with their patients decision making is to not offer personal opinions. It’s best to help patients have trust in their physicians’ and/or provider’s treatment plan while remaining hopeful for the patient in their corner. Explain and teach the patient with whatever their lack of understanding is (provide truthful information requested) while being sensitive to their receptivity and cognitive abilities (age group, etc). Provide soothing caretaking at the functional level and encourage self care and encourage as much independence as possible. It’s also important for the nurse to evaluate the safe treatment & care. Do revise as status changes occur.

Supporting a patient in a challenging treatment decision involves providing comprehensive information, explaining potential risks and benefits, and addressing their concerns. Listen empathetically to their preferences and values, helping them weigh options aligned with their goals. Empower the patient to make an informed choice that aligns with their values and priorities, ensuring they feel supported throughout the decision-making process.

I always relate it to what I would do for my family member - and i’m honest. I find this works well as people see you’ve thought about what they’re going through and that you’ve put yourself in their shoes. Its a way to be more relatable. It’s also a way to begin hard conversations. I find this is best in ethically and morally hard situations especially in resuscitation conversations when things are not looking well for families.

Put yourself in the patients physical, emotional, financial and family position. Your understanding and ability to be compassionate and patient will help you to know what to say and more importantly what not to say

Meet the patient at their level of acceptance and allow time for them to process information. It's important to evaluate how much they understand and how they best receive or learn information if further explanation or education needs to be given.