Discussion Question: Patient Preferences and Decision Making

NURS 6052 Discussion: Discussion: Patient Preferences and Decision Making

Walden University Discussion Question: Patient Preferences and Decision Making– Step-By-Step Guide

This guide will demonstrate how to complete the Walden University Discussion Question: Patient Preferences and Decision Making assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for Discussion Question: Patient Preferences and Decision Making

Whether one passes or fails an academic assignment such as the Walden University Discussion Question: Patient Preferences and Decision Making depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for Discussion Question: Patient Preferences and Decision Making

The introduction for the Walden University Discussion Question: Patient Preferences and Decision Making is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for Discussion Question: Patient Preferences and Decision Making

After the introduction, move into the main part of the Discussion Question: Patient Preferences and Decision Making assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for Discussion Question: Patient Preferences and Decision Making

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for Discussion Question: Patient Preferences and Decision Making

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for Discussion Question: Patient Preferences and Decision Making

According to Hoffmann et al. (2014), it is critical to combine evidence-based practice (EBP) and shared decision making (SDM) between the provider, patient, and family in order to achieve high-quality health care. SDM is a practice that has emerged in recent years in healthcare and is still being refined. SDM presents all medical care options while respecting the patient’s values and preferences. The benefits and risks of treatment are discussed, and all of the patient’s conditions are considered. If SDM is not used, the patient and family may experience emotional distress as well as undue physical stress (Kon et al., 2016)

SDM should have been used in the case of a 68-year-old man who needed his aortic valve replaced and had multiple comorbidities. The cardiologist explained why the aortic valve was needed, as well as the risks and benefits of the procedure. He also discussed the need for anticoagulant therapy. The patient had osteoarthritis and rheumatoid arthritis, for which he took nonsteroidal anti-inflammatory drugs (NSAIDs) and heavily relied on for pain relief. As the cardiologist explained, the gentleman chose to have the procedure because he would lose 1-2 years of life expectancy if he did not. He became distraught after the procedure, when the discharge instructions were given and he was told he couldn’t take his Ibuprofen for the rest of his life. He stated that without NSAIDs, his life would be miserable and that he would rather die than live in excruciating pain. He then told his family that he would take his Ibuprofen and that he didn’t mind the risk of bleeding because living in pain was worse. The discharge process could have been improved if better care coordination and SDM were done prior to the valve replacement, explaining the postoperative medication management.

What Effects Shared Decision-Making Has on Medical Treatment

SDM’s standard procedure includes an informative dialogue, reflection and consideration of all options, and the development of a treatment plan (Kon et al., 2016). SDM is critical at all stages of illness, particularly with chronic and end-of-life decisions. SDM and

advanced care planning (ACP), according to Deodhar et al. (2021), lay the groundwork for improved quality of life by clarifying patient and family expectations of health priorities. Furthermore, the benefits of SDM include an improvement in the provider-patient relationship, adherence to medical treatment, preparing individuals for critical illness, and making the difficult decision of when to withdraw from care. SDM must be adaptable with reassessment and modification in patient-centered treatment plans, as well as respect the patient’s preferences, values, and healthcare goals. SDM integration improves patient autonomy and psychosocial well-being (Nnate et al., 2021).

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In the preceding scenario, utilizing SDM for postoperative medications prior to the procedure would have reduced the patient’s stress and increased compliance. Discussing all medications could have resulted in the discovery of an alternative to NSAIDS following the procedure. Fortunately, this gentleman did not experience any bleeding complications; however, the unfortunate part is that he distrusts healthcare providers and believes they are not always forthcoming with health-care information.

The Importance of Patient Decision Aids

According to the Ottawa Hospital Research Institute (2019), decision aids (DA) have been developed to assist patients in making health-related decisions. These tools assist patients in processing their values and provide information on various options and possible outcomes. DAs are not intended to replace provider advice, but rather to improve the SDM process. According to Korger et al. (2021), the benefit of a DA is that it helps patients feel more prepared, informed, and confident when making important health care decisions. Furthermore, DAs assist patients in understanding their personal preferences in an unfamiliar area of medicine.

Aortic Valve Replacement Surgery from Healthwise was the DA I reviewed for heart valve replacement that may have helped the gentlemen I worked with (The Ottawa Hospital Research Institute, 2020).

This DA provided a thorough explanation of why the surgery was required, how it was performed, what the patient could expect post-operatively, and the benefits and risks of the procedure. It did mention that the patient would need to take an anticoagulant for the rest of his life. It did not, however, specify which medications the patient would be unable to take while on anticoagulants. As previously stated, DAs are not intended to replace healthcare professionals, but rather to supplement the discussion. When reviewing the section of the DA that discussed anticoagulants, it would have been the ideal time to go over medication and explain that NSAIDs were no longer an option for this gentleman. The risks of mixing the two medications could be discussed by the provider, the patient, and even a pharmacist. Another DA on anticoagulants could be introduced at this point in the conversation. Other medication options could be discussed during the collaborative, open-minded discussion. If NSAIDs were still his preferred treatment option, this could have been discussed prior to the procedure. A DA would have allowed the provider and the patient to have a more comprehensive discussion about the long-term implications of the surgery for this gentleman.

Discussion Aids in the Future

DA is a tool I was unaware of until this discussion post. A DA is something I can see myself incorporating into my practice, particularly for chronic conditions such as heart failure, chronic kidney disease, COPD, and end-of-life decisions, in order to educate and engage my patients and their families. DAs are well-organized and provide good discussion topics. This in-depth conversation will improve communication between the provider and the patient. Furthermore, it facilitates difficult conversations among family members and allows for early planning and preparation. It is the ideal time for patients to express their wishes because they are healthy and can speak for themselves, and the DA can relieve family members of the burden of making difficult decisions.

References

Deodhar, J., Nagaraju, S., Kirpalani, A., & Nayak, A. (2021). Shared decision-making, advance care planning for chronic kidney disease patients. Indian Journal of Palliative Care, 27, 33–36. https://doi.org/10.4103/ijpc.ijpc_71_21

Hoffmann TC, Montori VM, 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., M.D., Davidson, Judy E,D.N.P., R.N., Morrison, W., M.D., Danis, M., M.D., & White, Douglas B,M.D., M.A.S. (2016). Shared decision-making in intensive care units: Executive summary of the American college of critical care medicine and American thoracic society policy statement. American Journal of Respiratory and Critical Care Medicine, 193(12), 1334-1336. doi:10:1097/CCM.0000000000001396

Korger, S., Eggeling, M., Cress, U., Kimmerle, J., & Bientzle, M. (2021). Decision aids to prepare patients for shared decision making: Two randomized controlled experiments on the impact of awareness of preference‐sensitivity and personal motives. Health Expectations, 24(2), 257–268. https://doi.org/10.1111/hex.13159

Nnate, D. A., Barber, D., & Abaraogu, U. O. (2021). Discharge plan to promote patient safety and shared decision making by a multidisciplinary team of healthcare professionals in a respiratory unit. Nursing Reports, 11(3), 590–599. https://doi.org/10.3390/nursrep11030056

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from http://decisionaid.ohri.ca/

The Ottawa Hospital Research Institute. (2020). Aortic Valve Replacement Surgery. Retrieved from https://decisionaid.ohri.ca/AZsumm.php?ID=1028

Sample Answer 2 for Discussion Question: Patient Preferences and Decision Making

A patient in my care environment complained of dizziness and was admitted to the hospital. Her HBP was discovered. She was included in the assessment and management of the disease by the nurse in charge of the patient. After the diagnostic results were released, the nurse reviewed them with the patient, and together they devised a plan. Incorporating the patient’s values and preferences aided the nurse in customizing disease intervention. The nurse and patient, for example, agreed that the patient would exercise at least three times a week and consume a well-balanced diet to control the disease. The patient’s satisfaction with the nurse and the intervention enhanced once she was involved in the treatment plan. Clinicians must adopt the evidence-based practice and act in their patients’ best interests, which could include relying on judgment to help patients make decisions, According to Melynk & Fineout-Overholt, (2018).

The patient’s worth and preferences had an impact on the situation’s outcome. The first benefit of incorporating choices into the treatment plan is better clinical intervention quality. The nurse developed a solution that improved the patient’s outcomes (Kon et al., 2016). Another factor to consider is treatment efficacy. Because she was consulted before the prescriptions were provided, the patient joyfully followed the prescribed medication. Finally, she waited long to return to the hospital due to HBP, indicating that the method minimizes hospital readmissions (Schroy et al.,2014).

Ottawa personal/family decision guidelines (OP/FDG) were employed in this instance as a decision help. The model was helpful because it assisted the nurse in making social or health decisions with the patient (Melnyk & Fineout-Overholt, 2000). (2018). The tool was also beneficial in that it assisted the patient in deciding what to do next with their health. I can utilize this tool to establish goals for my professional development. We have a critical role to play in shared decision-making as healthcare practitioners. We provide evidence-based decisions and treatment while considering patients’ goals, values, and preferences (Carhuapoma & Hollen, 2018). By enhancing surrogate knowledge, a decision aid inventory can complement the clinician’s approach. They also assist people in decision-making by making apparent the decisions that must be made. They are more of a compliment than a replacement.

References

Carhuapoma, L. R., & Hollen, P. J. (2018). The Use of Decision Aids for End-of-Life Surrogate

Decision Making for Critically ill Stroke Patients: A Systematic Review. STROKE, 49. https://doi.org/10.1161/str.49.suppl_1.TP360

Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision-making in icus. Critical Care Medicine, 44(1), 188–201. https://doi.org/10.1097/ccm.0000000000001396

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare:

A guide to best practice (4th Ed.). Philadelphia, PA: Wolters Kluwer

Schroy, P. C., Mylvaganam, S., & Davidson, P. (2011). 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/10.1111/j.1369-7625.2011.00730.x

Sample Answer 3 for Discussion Question: Patient Preferences and Decision Making

Recently, an encounter with a patient reminded me of the importance of trying to understand your patient’s point of view. My team had provided care to a minor patient on the behavioral health unit. Despite marked family discord between the patient and his family, a seemingly safe discharge ensued. This patient was provided a vast array of community resources which helped the team to feel he would be well supported once discharged. This patient was diagnosed with ADHD, however, chose to refuse any attempt in providing him with medication as ordered by the provider. Fast forward a year and this patient was back on our unit. So many aspects of his life had changed, unfortunately, not for the better. He had not utilized the resources we provided for him at discharge and the relationship between him and his family continued to deteriorate. This patient explained that he had lived in 3 different states in the previous year since his discharge, living with various relatives, and was doing well until his parents forced him to return home. Upon returning home, the patient reported his immediate family members physically abused him and as mandated reporters, we contacted CPS to initiate an investigation. The patient refused to take any prescribed medications to treat his ADHD symptoms on this admission, as he had in the previous admission.

It was evident to my team and I that his impulsivity and restlessness were causing him undue stress however, he remained steadfast in his refusal to accept medications. One morning, I approached the patient and asked him why he continued to refuse meds. The patient reported that he did not want to be slowed down, needed to maintain control of his situation, and did not want to simply because that’s what his parents had begged him to do for years. The patient and I discussed his right to refuse medication, discussed the conflict that existed between him and his immediate family, and further explored why he felt the need to deny himself medications that could help him just to spite his mother. I suggested that he was capable of making good decisions to positively impact his life and that he may want to consider things from the lens of wanting to do just that. Ultimately, he chose to try the medication for “just one day” and the next day he decided that he would do the same. This continued for the remainder of his stay. He was less impulsive, less restless, and was able to maintain focused attention. When he was discharged, he was not discharged back to his family. I hope to not see him again on our unit as I hope he continues on the path to better himself, despite the toxic home environment he was raised in, as would late be corroborated by the investigators.

According to CMS, treatment plans must be individualized, and documentation must include short-term goals, as stated in the patient’s own words. (DHHS, 2006). This patient’s treatment plan included taking medications as prescribed as well as being able to recite what medication he was taking, what the dosage was, and the reason that he takes it. Treatment plans are a living document that evolves during a patient’s stay and helps to provide the evidence necessary to indicate that a patient is making headway and is meeting their goals. This patient had a goal to “be emancipated” when he was admitted, however, his goal evolved to include decision-making and he was able to meet the criteria of his formal treatment plan. According to Laureate, outcomes are driven by teams who make their vision come to life. (Laureate, 2018). I hope that my team and I contributed to this young man’s growth and that his outcome will be better than the ACE’s (adverse childhood events) study would suggest.

I selected the patient decision aid regarding whether to allow your child to take ADHD medication. (Healthwise, 2021). I found that this tool would likely be very helpful for our patients who need a resource to assist them in making informed decisions. I believe that knowledge is power and when written in a way that is easily comprehended, this tool can be the gateway into a patient having open discussions regarding their treatment. I am thankful to now know that this tool exists and suspect I may use it from time to time as the need arises. I found many interesting topics during the search and believe that when my family members and friends come to me with questions regarding their health, I will point them in the direction of the Ottawa decision aid.

References

Department of Health and Human Services (DHHS). (2006). Psychiatric unit criteria

worksheet. Accessed on 11/07/2021.

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS437.pdf

Healthwise. (2021). ADHD: should my child take medicine for ADHD? Accessed on11/08/2021.

https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=aa6

Laureate Education. (2018). Evidence-based Practice and Outcomes. Accessed on 11/08/2021.

https://content.waldenu.edu/content/laureate-academics/wal/instances/ms-nurs/nurs-

5052-210830-210710/module-06.html

Sample Answer 4 for Discussion Question: Patient Preferences and Decision Making

My work as a home hospice case manager has taught me a great deal about respecting patient preferences, even when it’s difficult as a clinician. I oriented to hospice many years ago and was shocked that my first hospice patient was also a full code. I was baffled how a patient could be both admitted into hospice yet still have active orders that ‘everything’ was to be done to save her life, which would inevitably lead to the hospital. It was incongruent. My preceptor whole-heartedly agreed.

We attempted to clarify what she wanted during our first several visits since the two facts were contradictory. However, we quickly learned that this patient was utterly unwilling to have any conversation that broached her coming death, either with her family or us. My preceptor attempted, several times and in the most skillful ways I’ve ever seen, to start difficult conversations, which included: the patient’s code status; a request from the patient’s daughter for a care conference to address family questions and concerns; and the hospice team’s strong expectation for how this particular patient might die (we anticipated a sudden bleed-out due to her sarcoma rapidly growing near her carotid). We also wanted to provide support, education, and preparation to the family to help answer their questions; support their anticipatory grief, and help prepare them for their loved one’s potentially dramatic death. However, the patient adamantly refused to allow us to discuss anything with them. She was also unwilling to speak about any of these concerns herself with any hospice team member. She would say things like ‘I just want to enjoy the day,’ and ‘You make me sad when you bring these things up.’ After several team members’ attempts, we had to acknowledge and accept that this patient was not ready (and never was prepared) to discuss or prepare for her death with her family or us.

Our facility had a belief in the shared-decision making model, described by Melnyk & Fineout-Overholt (2019), in which research, clinician knowledge, and patient preferences are equally considered. In this situation, the patient’s preferences overrode the other two. So, we changed our approach at visits, and instead of focusing conversation on her code status or concerns from her family, we instead honored her desire to have pleasant talks, complete wound care, and manage her pain. Her treatment plan encompassed what she wanted, and these goals became what we wanted on her behalf.

Ultimately, she entered the actively dying phase very quickly (no bleed out), and her husband was able to call us to the home when she became unresponsive. He signed off on the DNR 45 minutes before she died. In the end, as frustrated as her family was that she had refused to allow them to communicate with hospice, they also stated this was precisely her personality in life. They appreciated that we had respected her ‘feisty and independent’ nature (their words), even though it had been difficult for all involved. By including her preferences and values in a shared-decision making approach, this scenario’s trajectory held risk for a potentially traumatic experience for her family had she bled out. It also created the possibility that she wouldn’t die at home, which had been her initial expressed desire on admission to hospice. However, in the end, her wishes for ‘pleasant’ visits from hospice were met by the team, and we also managed her wound care and pain quite well. It was a successful patient care experience that taught me a great deal about respecting patients’ rights and desires.

The patient decision aid that I found through the Ottawa Hospital Research Institute (2019) is called the Plan Well Guide. It helps guide difficult conversations related to planning for severe illness and medical treatment options (Heyland, 2019). I don’t believe that this patient decision aid would have made a difference for the scenario I described above – she knew what she wanted and had no problem relaying that to us. Still, I think this tool could be an excellent option for future patients and even friends and family. The site has short videos showing actual patients and their loved ones discussing their experiences with having hard conversations about care, but realizing that they felt better afterward, having made their wants known to their family.

The critical point for clinicians to understand when considering patient preferences in the shared decision-making model is that patients may make decisions that we disagree with or that we feel are ill-informed, as in the example I describe. Our team never had a chance to discuss with our patient what our concerns were or explain how we wanted to support her family; she refused it all. Clinicians have to be prepared to present information in several ways (direct conversations, written materials, websites, videos) and then be ready for the patient to reject this information or not use it in the way we expect. We may have strong feelings about how the patient should decide their treatment plan and who they should include in that decision. In the end, it is what the patient decides that guides the treatment plan. It is the most ‘challenging’ patients that can teach providers the most because if they are indeed in control of their treatment, then we must be ready and willing to accept what they decide…even when we disagree.

Sample Answer 5 for Discussion Question: Patient Preferences and Decision Making

Introduction

This paper will provide examples of how incorporating or not incorporating patient preferences and values impact their outcomes. Then, we will explain how including patient preferences and values influence their health situation and are reflected in their plan of care. Finally, we will discuss decision aid support and its impact on patient decision-making and use in professional practice.

The situation related to patient preference and value impacts outcomes in the plan of care.

The National Kidney Foundation (2020) state that, in the United States, 37 million adults are estimated to have chronic kidney disease, and approximately 90 percent don’t know they have it. Risk factors associated with CKD are diabetes, high blood pressure, heart disease, obesity, and family history. According to Hoffman et al. (2014), evidence-based medicine should begin and end with the patient. For example, when a patient transitions from chronic kidney disease (CKD) to end-stage renal disease (ESRD), the patient is faced with several treatment options that are critical to their survival. These treatments are necessary for the rest of their lives, so patients need to choose the most suitable treatment for them. According to Green et al. (2018) many patients are unprepared for kidney failure treatments—even when they have been under nephrology specialty care for years. Nephrologists are often unable to predict the timing of kidney failure. Sometimes patients with advanced kidney disease experience rapid decline in kidney function, which leaves little time for a nephrologist to help patients prepare in advance (p. 2). With electronic health records (EHR) and analysis, algorithms predict CKD patient characteristics and laboratory measures. The nephrologist can recognize patient needs or prognosis of kidney transition based on age, gender, eGFR, urine albumin, creatine ration, calcium, phosphorus, albumin, and bicarbonate focus, providing patients with the knowledge, skills, and support in shared decision making (p. 5). Kon et. (2016) note three elements of a shared decision-making (SDM) approach include information exchange, deliberation, and making a treatment decision addressing the patient preference, values, and goals of care (p. 1334). The impact in outcomes is that patients and families who are educated, informed, and supported throughout their diagnosis can better participate in SDM, accommodating their medical needs and preferences, leading to more satisfying outcomes and relationships.

Patient preferences and values

Evidence-based practice requires a patient-centered approach when it comes to decision-making. The Institute of Healthcare Improvement (IHI, 2013) describes “patient-centered” as placing an international focus on patients’ cultural traditions, values, personal preferences, family issues, social circumstances, and lifestyle. This approach leads to better patient engagement and outcomes (Melnyk & Fineout-Overholt, 2019, p.227). The evaluation of factors related to home and family life can make or break a successful care plan; for example, a young family of four with two children under the age of four recently found out that the husband/father needed to start dialysis therapy. This family has already been dealing with financial hardship, unstable marital concerns, and the responsibility of raising two small children. The husband reports a lack of support once starting treatment from his wife, who feels burdened and unappreciated. He is afraid of losing her and his children and feels burdened with guilt and worry. The family needs a transdisciplinary care plan that focuses on the patient’s best options for treatment (given his current circumstances), including transplant and home therapies. This care plan would include counseling support to help save their marriage and adjust to this new chronic health diagnosis, care management to help provide support, financial guidance and options, and dietician to ensure the patient has the knowledge needed to optimize his therapy. William Osle’s quote, “It is much more important to know what sort of a patient has a disease than what sort of disease a patient has (Melnyk & Fineout-Overholt, 2019, p. 229) embodies the reason why patient preferences and values determine clinical decisions and outcomes.

Decision-Aid Support and Impact on Decision-Making

Decision aids are a valuable tool in helping patients make the right decisions based on their values and needs. The Ottawa Hospital Research Institute (2019) provides an A-Z inventory of decision aids. For example, when searching the term, “Kidney”: multiple decision aid tools populate to relating to chronic kidney disease, end of life issues, and kidney failure to include dialysis choice, dialysis; doing the right choice, My life, My dialysis choice, advanced care planning: should I stop kidney dialysis, Kidney Failure: Should I start dialysis? This tool provides patients with treatment options, pathways, and outcomes. Clinicians use it to support patient preference and guide patient and provider decision-making (Melnyk & Fineout-Overholt, 2019, p. 228). In the example of the kidney patient who has multiple barriers to achieving optimal care, this information would have provided him with the options needed before starting dialysis. It would give a platform of shared decision between himself, his wife, and his provider. Clinicians should use decision aids in their daily practice with patients newly diagnosed or with patients who are not managing their diagnosis well. These aids will support active engagement by the patient and lead to both an improved patient and provider experience and outcomes.

References

Green, J. A., Ephraim, P. L., Hill-Briggs, F. F., Browne, T., Strigo, T. S., Hauer, C. L., Stametz,

A., Darer, J. D., Patel, U. D., Lang-Lindsey, K., Bankes, B. L., Bolden, S. A., Danielson, P., Ruff, S., Schmidt, L., Swoboda, A., Woods, P., Vinson, B., Littlewood, D., Jackson, G., … Boulware, L. E. (2018). Putting patients at the center of kidney care transitions: PREPARE NOW, a cluster randomized controlled trial. Contemporary clinical trials, 73, 98–110. https://doi.org/10.1016/j.cct.2018.09.004

Hoffmann, 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: Executive summary of the American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188-201. Doi:10.1097/NND.0000000000000483

National Kidney Foundation. (2020) NKF statement on the ESRD treatment choices model

(ETC) and policies to improve kidney patient choice: Kidney disease facts. https://www.kidney.org/news/nkf-statement-esrd-treatment-choices-model-etc-and-policies-to-improve-kidney-patient-choice

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from

https://decisionaid.ohri.ca/