20 Feb Patient Involvement, Social Determinants of Health, and Decision Aids Study Notes

1. Introduction
Patient-centered care: A healthcare approach that respects and responds to patient preferences, needs, and values.

Decision-making in healthcare: Involves collaboration between patients and providers to select treatment options that align with medical evidence and patient priorities.

Decision aids: Tools designed to help patients understand options, weigh benefits/risks, and make informed choices.

Social determinants of health (SDOH): Conditions in which people are born, grow, live, work, and age that influence health outcomes.

2. Importance of Patient Involvement in Treatment Decisions
Ethical foundation: Respect for autonomy.

Clinical benefits:

Improved adherence to treatment.

Better health outcomes.

Reduced decisional conflict.

Psychological benefits:

Increased satisfaction.

Reduced anxiety.

Greater trust in providers.

3. Barriers to Patient Involvement
Provider-related: Time constraints, paternalistic attitudes.

Patient-related: Limited health literacy, cultural beliefs, fear of authority.

System-related: Lack of resources, fragmented care, inadequate access to decision aids.

4. Social Determinants of Health (SDOH)
Economic Stability: Income, employment, financial security.

Education Access and Quality: Health literacy, ability to understand treatment options.

Healthcare Access and Quality: Insurance coverage, availability of providers.

Neighborhood and Built Environment: Safety, transportation, housing.

Social and Community Context: Support networks, cultural norms, discrimination.

Table: Examples of SDOH Impact on Treatment Decisions

Determinant Example Impact
Economic Stability Patient declines costly medication despite efficacy
Education Low literacy limits understanding of risks/benefits
Healthcare Access Lack of insurance prevents follow-up care
Neighborhood Unsafe area limits ability to attend appointments
Social Context Cultural beliefs influence acceptance of treatment
5. Ottawa Hospital Research Institute Decision Aids
Purpose: Provide structured information to support shared decision-making.

Types:

General decision aids.

Specific condition decision aids (e.g., diabetes, cancer, cardiovascular disease).

Features:

Evidence-based summaries.

Clear presentation of options.

Values clarification exercises.

6. Hypothetical Scenario (HIPAA-Compliant)
Situation: A middle-aged patient with early-stage breast cancer was presented with two options: lumpectomy with radiation or mastectomy.

Observation: The patient was initially not included in the decision-making process; the physician leaned toward mastectomy for clinical certainty.

Impact:

Patient felt anxious and disempowered.

Later, when preferences were considered, she chose lumpectomy with radiation, aligning with her values (body image, recovery time).

SDOH Considerations:

Economic stability: Concern about missing work during recovery.

Healthcare access: Availability of radiation therapy nearby.

Social context: Family support influenced decision.

7. Impact of Incorporating Patient Preferences and SDOH
Positive Outcomes:

Improved adherence to treatment.

Enhanced satisfaction.

Reduced decisional regret.

Trajectory Change:

Without patient input: Risk of non-adherence, dissatisfaction.

With patient input: Treatment aligned with values, better psychosocial outcomes.

8. Value of Decision Aid Selected
Decision Aid: Ottawa Hospital’s Breast Cancer Surgery Decision Aid.

Benefits:

Provides clear comparison of lumpectomy vs. mastectomy.

Includes survival rates, recurrence risks, side effects.

Offers values clarification exercises.

Contribution to Effective Decision-Making:

Reduces decisional conflict.

Improves patient knowledge.

Encourages shared decision-making.

9. Application in Professional Practice
Clinical Use:

Integrate decision aids into patient consultations.

Use values clarification to guide discussions.

Educational Use:

Train staff in shared decision-making.

Personal Use:

Apply decision aids when facing personal/family health choices.

10. Reflection and Lessons Learned
Key Lesson: Patient involvement is essential for ethical, effective, and sustainable healthcare.

Decision aids: Bridge the gap between medical evidence and patient values.

SDOH: Must be systematically considered to ensure equitable care.

15‑Question Quiz
Multiple Choice (Select One Answer)
Patient-centered care emphasizes:

A) Provider authority

B) Patient preferences and values

C) Cost reduction only

D) Technology use only
Answer: B

Which ethical principle supports patient involvement?

A) Beneficence

B) Autonomy

C) Justice

D) Non-maleficence
Answer: B

A barrier to patient involvement is:

A) Shared decision-making

B) Limited health literacy

C) Family support

D) Decision aids
Answer: B

Social determinants of health include:

A) Genetics

B) Economic stability

C) Weather

D) Personality traits
Answer: B

Which determinant affects ability to afford medication?

A) Education

B) Economic stability

C) Neighborhood safety

D) Social context
Answer: B

Ottawa Hospital’s Decision Aid Inventory provides:

A) Legal advice

B) Evidence-based decision tools

C) Insurance coverage

D) Genetic testing
Answer: B

Decision aids help patients by:

A) Reducing decisional conflict

B) Limiting choices

C) Avoiding preferences

D) Ignoring values
Answer: A

In the scenario, the patient’s preference was:

A) Mastectomy

B) Lumpectomy with radiation

C) No treatment

D) Chemotherapy only
Answer: B

Not including patient preferences can lead to:

A) Improved adherence

B) Decisional regret

C) Enhanced satisfaction

D) Empowerment
Answer: B

Values clarification exercises are part of:

A) Decision aids

B) Insurance plans

C) Lab tests

D) Billing systems
Answer: A

Healthcare access as a determinant includes:

A) Insurance coverage

B) Family support

C) Cultural beliefs

D) Employment status
Answer: A

Which determinant influenced the patient’s choice in the scenario?

A) Weather

B) Family support

C) Genetics

D) None
Answer: B

Decision aids contribute to:

A) Shared decision-making

B) Provider dominance

C) Reduced patient knowledge

D) Ignoring evidence
Answer: A

Nurse leaders can use decision aids to:

A) Train staff in shared decision-making

B) Limit patient involvement

C) Reduce treatment options

D) Avoid patient education
Answer: A

The ultimate goal of incorporating SDOH and preferences is:

A) Equitable, patient-centered care

B) Provider convenience

C) Reduced patient autonomy

D) Increased decisional conflict
Answer: A