Discussion: Patient Preferences and Decision Making

Discussion: Patient Preferences and Decision Making

NURS 6052 Discussion: Patient Preferences and Decision Making

Having worked in the covid unit, a lot has changed in the type of care patients receive. Often, it feels like the nursing services involved are on the meter of the life-or-death spectrum. It is not like it used to be where patients had hope of getting better and going back to their homes in a short duration of time. Nowadays, patients are hospitalized for months before they can be considered safe for discharge or are transferred to critical care units after conditions worsen or death. In addition, the type of clinical expectations after covid diagnosis has made patients and their families fear health outcomes. That fear is often translated to the relationships eventually formed between clinicians and patients and their families.

For example, I was privileged to care for a very critically ill patient suffering from covid a few weeks ago. The patient was female in her late 70s, alert and oriented x4, had a do not resuscitate code status, with a history of diabetes, hypothyroidism, and hypertension. The patient was on heated high-flow and nighttime Bipap for ventilation which worked for a few weeks, and then we had to switch to Bipap continuous due to desaturation episodes. Pt continued to function with capacity, although her husband was the medical power of attorney. After several weeks passed patient condition continued to deteriorate, prompting the end-of-life care talks from the doctors. The patient was not on board with comfort care because she and the family believed comfort care is like cheating death and wanted to let it occur naturally. This situation was difficult for everyone, especially for the patient who continued to suffer. But because providers had to follow the patient and family wishes, the patient remained on the Bipap for almost two weeks before passing in agony. It was sad and heartbreaking for the nurses to watch her go through the pain without relief, but we understood it was not our place to make decisions, except we served as teachers and consultants when we were required to do so (Pattison, 2020).

However, we (doctors and nurses) informed the patient and family of what it meant to be under comfort care. The patient was aware that CC meant pain relief, comfort, and quality of life (Healthwise, 2021). Current treatments continued but gently aimed to make the patient comfortable until she was ready to stop all treatments together. As shared decision-making is the component of patient-centered care, doctors, nurses, and family members respected the patient’s decision to endure the pain until death; failure to comply would have had significant ethical consequences to the hospital (Kon et al., 2016). It is protocol in the unit that when a doctor orders palliative care, a Chaplin comes by to consult with the patient on what they would wish to receive at the end of life. Formulating a patient-oriented end-of-life care plan is crucial to include the patient’s wishes, advance directives, funeral arrangements, and post-mortem care (National Institute on Aging, 2021).


healthwise Staff. (2121). Advance Care Planning: Should I Stop Treatment That Prolongs My Life? Retrieved from healthwise:

Kon, A., Davidson, J., Morrison, W., Danis, M., & White, D. (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, Vol. 193, Iss. 12, 1334-1336.

National Institute on Aging. (2021). Making Decisions for Someone at the End of Life. Retrieved from National Institute on Aging:

Pattison, N. (2020). End-of-life decisions and care in the midst of a global coronavirus (COVID-19) pandemic. Elsevier Public Health Emegercy Collection, 58: 102862. doi: 10.1016/j.iccn.2020.102862.

Thank you so much for sharing your patient experience and, unfortunately, a sad reminder that to this day, two years into the pandemic, we still deal with experiences such as yours. COVID-19 has changed the outcome of most patients because, as you mentioned, this is a matter of life or death; these patients can decline at any given moment. There might be a few days where they might seem critically stable, and you think, woohoo! That’s it, this is it, this might get better from here, we must be patient and continue to prone our patients and have them skip meals (if the patient eats, they desaturate). When you start to see the slightest glimmer of hope among your patient, they decline and must get intubated. Cheruku et al. (2022) researched COVID-positive patients on palliative care, concluding that patients on palliative care had the main goal of relieving and preventing a patient’s suffering. Cheruku et al. (2022) did notice an influx of patients on palliative care that was COVID positive. As Melnyk and Fineout-Overholt (2019) express, how healthcare team members can identify and understand a certain diagnosis and implement a treatment plan does not mean the patient or family members will agree. In this case, your patient and family members deciding what treatment their loved one can and cannot get is sometimes detrimental when there is a lack of education or understanding. There sadly seemed to be a lack of understanding on the family’s side and the patient had to suffer the consequences.


Cheruku, S. R., Barina, A., Kershaw, C. D., Goff, K., Reisch, J., Hynan, L. S., Ahmed, F., Armaignac, D. L., Patel, L., Belden, K. A., Kaufman, M., Christie, A. B., Deo, N., Bansal, V., Boman, K., Kumar, V. K., Walkey, A., Kashyap, R., Gajic, O., & Fox, A. A. (2022). Palliative care consultation and end-of-life outcomes in hospitalized COVID-19 patients. Resuscitation170, 230–237.

Melnyk & Fineout-Overholt (2019). Evidence-based practice in Nursing & Healthcare: A guide to best practice. Wolters Kluwer.

RE: Discussion – Week 11

Patient Preferences and Decision Making

Excellent patient care involves shared decision-making and combines evidence-based medicine and patients’ values, preferences, and circumstances (Hoffman et al., 2014). Incorporating patient preferences and values into a patient treatment plan is significant. Patients should be involved in their care in all aspects of their treatment plan. Patients should be able to decide which medications to take, what interventions they want, and address any other questions or concerns with their treatment plan. Montori et al. (2013) discuss evidence-based practices as a golden standard to produce better patient outcomes but providing optimal healthcare considers the individual patient preferences and values of patient-centered care.

Patient preferences can impact the outcome of a treatment plan by offering more effective and efficient care. Recently, I cared for a newly diagnosed diabetic type 2 patient. This patient was a 20-year-old male who recently got a new job at a fast-food restaurant and had no idea he had type 2 diabetes when he collapsed at work. As I continued to care for the patient, we talked about his feelings on the new diagnosis and the things the doctors said to him. Illness is a biological and social process; healthcare professionals need to acknowledge the social and cultural factors that affect the healthcare encounter (Siminoff, 2013).

For example, the patient was a very young and active person. He was a full-time student and hung out with friends. Before his diagnosis, he did not take any home medications. He wanted to know if taking insulin would be the best choice. Taking his blood sugar before meals and at bedtime seem to be overwhelming. He expressed his busy schedule as a full-time student and working full time. We talked about information he heard about lifestyle changes and asked what changes were needed. Since this was a newly diagnosed young, active student, he was more inclined not to take insulin and stick himself four times a day since his time was minimal with the hectic schedule. He expressed interest in making lifestyle changes and other hypoglycemic medications.

On the other hand, a much older patient may be inclined to take insulin and closely monitor their blood sugar before meals and bedtime because they have a caregiver or a loved one looking after them. An older adult may be more resistant to making lifestyle changes due to lack of mobility and going to the store and purchasing healthy foods.

Including patient preferences and values in a treatment plan can impact the trajectory of the situation by creating a patient-centered treatment that can be effective to the patient and produce better outcomes. By involving the patient, the patient will be more inclined to do specific interventions, take medications as scheduled, and comply with the treatment plan. Incorporating patient preferences and values can impact the outcome of a treatment plan by prioritizing the outcomes and deciding the best option for the patient.

Patient decision aids can contribute to effective decision-making by providing the facts to make the best personal choice. I selected the Healthwise decision aid. I would use this decision aid in my professional practice and personal life. This aid is valuable and explores treatment options. It has six different steps for the patient to complete to aid in decision-making. The patient can get the facts, compare options, rate their feelings and decision about treatment, and take a quick quiz to reinforce understanding of decision (Healthwise, n.d.). Healthwise is an excellent decision aid for patients and family members. I would recommend this decision aid tool to my patients to further explore their options and gain confidence in their treatment decisions. I will use this decision aid to help patients and families fully understand that they are making the right choice for them.


Healthwise. (n.d.). Diabetes type 2: Should I take insulin?. Retrieved February 9, 2022, from

Hoffmann, T.C., Montori, V.M., Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA, 312(13):1295–1296.

Montori, V.M., Brito, J.P., Murad, M.H. (2013). The optimal practice of evidence-based medicine: Incorporating patient preferences in practice guidelines. JAMA,310(23):2503–2504.

Siminoff, L. A. (2013). Incorporating patient and family preferences into evidence-based medicine. BMC medical informatics and decision making13(S3), S6.

RE: Discussion – Week 11

My experience was with a patient that had a missed miscarriage at 9-10 weeks in which spotting of blood had already begun. The patient was provided with three options going forward; she could either let the miscarriage continue on its own, take medication to speed up the miscarriage, or have a surgical procedure to remove the pregnancy. The provider discussed with the patient each option in detail to include the normal course of events with each option. The provider also discussed with the patient the risks of each option. At that point the provider let the patient and her partner discuss which option was best for them and answered any questions they had during their decision making process.

By respecting the patients personal values and wishes the provider allowed for a patient-centered experience to guide the decision making process (Melnyk & FineoutOverholt, 2018). Although the end result was the loss of pregnancy with any of the options, by the provider supporting the patient through her decision, the process was made a little less stressful for the patient.

Shared decision making occurs when the provider presents all options to include benefits and risks and works with the patient to ensure that their personal preferences are included into the decision making process (Hoffman, Montori, & Del Mar, 2014). By incorporating shared decision making into practice, the patient may feel more in control of their healthcare and therefore more likely to be compliant with the treatment plan. Often times patients are non-compliant as they are only provided with one option and expected to comply, when in fact it may not be in line with their personal values. By allowing the patient to make an informed and shared decision the patient was able to make a decision that aligned with her values and understood and complied with the providers instructions on carrying out the decision. 

The patient decision aid on miscarriage was a good tool to help inform patients of all the available options as well as the risks and benefits of each option. It also provided a tool to help evaluate your feelings in regards to each option to help you make the decision that is best for you. The decision tool also explains how if you chose a non-surgical route such as “watch and wait” or medication, if all pregnancy tissue is not expelled then surgical intervention will be necessary (Healthwise Staff, 2021). This may have some women decide to opt for the surgical intervention from the start, as it is the quickest and most effective way to rid the body of the tissue. In practice, this tool can be a helpful way to allow the patient to make the most informed decision that is in line with their values and preferences. 


Healthwise Staff. (2021, June 16). Miscarriage: Should I Have Treatment to Complete a Miscarriage. Patient decision AIDS – ottawa hospital research institute. Retrieved November 10, 2021, from

Hoffmann, T. C, Montori ,V. M, & Del Mar, C.  (2014). The Connection Between Evidence-Based Medicine and Shared Decision Making. Journal of American Medical Association. 312(13), 1295–1296. doi:10.1001/jama.2014.10186

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

RE: Discussion – Week 11

I just encountered a situation that may or may not be considered the patient being brought into their plan of care. I work mainly with adolescents and pediatrics in acute inpatient psychiatric care. These kids are very mentally ill. So, I was passing medications at dinner time, which is coincidentally change of shift. I was helping the other nurse on the pediatrics unit, I work the adolescents, by passing her medications while she was on the phone with a parent. One of the kids, maybe 13 years old female, was prescribed an SSRI for depression. She had no idea that she had it or what it did. I told her that of course she had every right to refuse the medication. She explained to me “I can do this on my own without medication”. I asked her if she knew about what the medication did and why she needed it. I went on to explain neurotransmitters and receptors and how the medication worked with them to boost her serotonin. She was shocked and immediately took her medication. After I told her that I wasn’t going to pressure her into taking it, but that she should always know why we take medication and what it does to our body. She shocked me and told me that no one had explained the medication to her, nor did they explain how they work. She told me that because I explained it to her in a way, she understood that she gladly took the medication. I found out later that she never refused that medication again and when I later asked her about it, she agreed that she needed it and was already starting to feel better.

Had I not explained to this adolescent why she was taking the medication, she may have refused multiple times or never taken it. This would have impacted her greatly in that she could benefit immensely from taking the medication. By explaining the medication properties to her, she was able to make an informed decision on her own. I treated her like a person, not just a patient or a child.

I spend a lot of time with my adolescent patients educating them on medications and neurology. I know that many of the nurses that I work with do very minimal education on medication as they don’t know much more than what the provider has told them or written in the medication indication section. ”Nurses have strong positive attitudes toward the necessity and processes underpinning successful patient medication education; yet, they may not act fully upon these beliefs” (Bowen et al, 2017). I think that the potential to want to educate patients is there, but many nurses lack the information and lack the motivation to seek it out. “Another significant finding from this study was that favorable treatment perception contributes to significantly higher rates of adherence to treatment with psychotropic medications irrespective of all other nonmodifiable demographic factors stated above” (Chawa et al, 2020). Knowing that by educating your patients, you can in fact help medication adherence and continued treatment following discharge. “Treatment efficacy, belief, and perceptions about the antidepressant were major influencing factors during the implementation phase of adherence” (Srimongkon et al, 2018). Knowing how best to talk to your patients starts with building trust.


Bowen, J. F., Rotz, M. E., Patterson, B. J., & Sen, S. (2017). Nurses’ attitudes and behaviors on patient medication education. Pharmacy Practice15(2), 930.

Chawa, M. S., Yeh, H. H., Gautam, M., Thakrar, A., Akinyemi, E. O., & Ahmedani, B. K. (2020). The Impact of Socioeconomic Status, Race/Ethnicity, and Patient Perceptions on Medication Adherence in Depression Treatment. The Primary Care Companion For CNS Disorders22(6).

Srimongkon, P., Aslani, P., & Chen, T. (2018). Consumer-related factors influencing antidepressant adherence in unipolar depression: a qualitative study. Patient Preference and AdherenceVolume 12, 1863–1873.

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.

Discussion: Patient Preferences and Decision Making

Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.

What has your experience been with patient involvement in treatment or healthcare decisions?

In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.



Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.


To Prepare:

  • Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
  • Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at
  • Links to an external site. were considered in the treatment plan Social determinants of health can affect a patient’s decision as these are conditions in the patient’s environment, such as economic stability, education access, health care access and quality, neighborhood, and social and community context.
  • NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.

By Day 3 of Week 11

Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences, social determinants of health

Links to an external site., and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences, social determinants of health, and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.

(Please Note: The underlined “social determinants of health” in the above content is meant to hotlink to the following Walden webpage and content:

Social Determinants of Health – Social Determinants of Health – Academic Guides at Walden 

Respond to at least two of your colleagues on two different days 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.

Patient preferences mean a patient’s choice to decide about their health and treatment based on their experiences, beliefs, and values. However, these choices and preferences are not left entirely to the patients, and there is a need for a shared decision-making process between the providers and the patients (Gurmu, 2022). In my previous practice, a 36-year-old male presented with complaints of insomnia that had lasted for about four months. The patient stated that he had been prescribed Benadryl at a community clinic but stopped taking it due to next-day drowsiness. He had researched about Benadryl and learned that it is an antihistamine. He, therefore, asked if he could get a prescription without an antihistamine.

The NP informed the patient of the available medication options, which included Trazodone, Vistaril, and Ambien. They discussed the benefits and side effects of each medication and established that Trazodone would be the most beneficial due to its established tolerability and efficacy in reducing insomnia. After four weeks, the patient reported that his sleep quality had significantly improved and had no issues initiating or maintaining sleep. He also reported that the medication had no side effects. Respecting the patient’s values and treatment preference contributed to positive outcomes since he adhered to the treatment, resulting in the desired outcomes (Russo et al., 2019).

The patient decision aid appropriate for this scenario is the “Insomnia: Should I Take Sleeping Pills?” The target audience for this decision aid includes persons thinking of taking sleeping pills for insomnia. It offers two choices: Use sleeping pills in a short time in addition to lifestyle modification or manage insomnia with only lifestyle interventions (Ottawa Hospital Research Institute, 2019). The aid can guide clinicians in making appropriate decisions when treating patients with insomnia as it guides one to initiate pharmacotherapy or sleep hygiene interventions. I can utilize the aid in my future nursing practice when managing patients with sleep disorders and identifying cases to prescribe pharmacotherapy or lifestyle interventions.


Gurmu, Y. (2022). Patient Preferences in Shared Decision Making During Healthcare and Associated Factors Among Adult Admitted Patients at Public Hospitals of West Shoa Oromia, Ethiopia. Patient preference and adherence16, 1781–1786.

Russo, S., Jongerius, C., Faccio, F., Pizzoli, S. F. M., Pinto, C. A., Veldwijk, J., Janssens, R., Simons, G., Falahee, M., de Bekker-Grob, E., Huys, I., Postmus, D., Kihlbom, U., & Pravettoni, G. (2019). Understanding Patients’ Preferences: A Systematic Review of Psychological Instruments Used in Patients’ Preference and Decision Studies. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research22(4), 491–501.

Ottawa Hospital Research Institute. (2019, June 26). A to Z summary results. Patient Decision Aids – Ottawa Hospital Research Institute.