Peer Responses

Responding to Princess Agwu

Hello Agwu,

Great work prioritizing shared decision-making (SDM) and social determinants of health (SDOH) in patient care. Overcoming barriers such as food security and cultural acceptance will significantly improve compliance and patient outcomes. Involving a dietitian and involving the patient in community meal programs were commendable strategies: Peer Responses.

To make it even more effective, having mobile nutrition therapy or community meal delivery programs included could make healthy foods even easier for food-desolate communities to access (Ziso et al., 2022). Having grocery stores selling healthy, affordable, and culturally relevant foods in nearby locations could make it even more feasible.

To facilitate dissemination at a more significant level, integrating decision aids in electronic medical records can allow clinicians to review SDOH periodically. On an ongoing basis, offering patient education via electronic health tools and community programs can enable citizens to manage and maintain control over their well-being (Haleem et al., 2021). All such interventions can bridge care gaps, and ongoing patient engagement can ensure long-term patient improvement.

References

Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, 2(2), 100–117. https://doi.org/10.1016/j.sintl.2021.100117

Ziso, D., Chun, O. K., & Puglisi, M. J. (2022). Increasing access to healthy foods through improving food environment: A review of mixed methods intervention studies with residents of low-income communities. Nutrients, 14(11), 2278. https://doi.org/10.3390/nu14112278

Responding to Catherine O Richards

Hello Catherine,

Great work; your post effectively communicates the value of patient preference and social determinants of care in care planning. Overcoming financial barriers, food security, and cultural food preferences facilitate care planning, becoming a whole-person intervention. Engagement with a social worker and a dietician increases patient compliance and facilitates patient empowerment and trust in care providers (Nagy et al., 2022). Revising the meal plan with foods that are relevant and accessible is a thoughtful and long-term intervention.

Your discussion about the use of decision aids is commendable, with specific observations about aids such as the Diabetes Decision Aid and its role in shared decision-making. By mapping care planning onto patient values, such aids promote patient activation and compliance, with a beneficial impact in terms of long-term outcomes (Tringale et al., 2022). Your practice confirms the worth of a patient-centered model in long-term disease management and a sound platform for empathetic and effective practice.

References

Nagy, A., McMahon, A., Tapsell, L., & Deane, F. (2022). The therapeutic relationship between a client and dietitian: A systematic integrative review of the empirical literature. Nutrition & Dietetics, 79(3). https://doi.org/10.1111/1747-0080.12723

Tringale, M., Stephen, G., Boylan, A.-M., & Heneghan, C. (2022). Integrating patient values and preferences in healthcare: A systematic review of qualitative evidence. BMJ Open, 12(11). https://doi.org/10.1136/bmjopen-2022-067268

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PA Princess Agwu

In evidence-based medicine (EBM), the best available scientific evidence from clinical research is used to help make patient care decisions (Tenny & Varacallo, 2022). During shared decision-making (SDM), the clinician and the patient participate. Traditionally, shared decision-making (SDM) refers to a cooperative process through which patients, in collaboration with their clinicians, are urged to examine the available treatment solutions as well as their risks and benefits, express their choices, and aid in determining what plan is most appropriate for them (Montori et al., 2023).

To provide quality healthcare, both are interdependent. Due to limited resources, time constraints, clinician expertise, and/or suitability for certain patient situations, SDM can be challenging to implement (Lee et al., 2022). A description of the situation and how the inclusion of patient wishes, social determinants of health (SDOH), and values influenced the success of the medical plan.

In the telemetry unit, I came across a 58-year-old male patient with diabetes who had difficulty managing his blood sugar levels. The condition of the patient remained poorly controlled despite the prescription of medication and the provision of standard dietary advice.

Further discussions revealed that key social determinants of health compromised his management: He lived in a food-barren area where fresh produce was limited, labored long hours without time to prepare meals, and had limited financial resources. In addition, he expressed a strong preference for certain traditional foods based on his cultural background. SDOHs are non-medical factors influencing health (Chelak & Chakole, 2023). As a result of SDOH, health inequities can persist across generations.

SDOH examples are food insecurity, social relationships, housing, income, education, the environment, and discrimination.

There was a lack of consideration of these factors in the initial treatment plan, which led to frustration and non-adherence. The trajectory changed when I incorporated the patient’s preferences and values. As an example, we collaborated with a dietitian to develop a meal plan that is culturally relevant while using affordable, shelf-stable ingredients.

Additionally, we provided him with information about a community program that provides healthy meal kits.

As a result of these adjustments, the patient could participate more actively in his care. This led to improved blood sugar control and satisfaction. During the care process, patient engagement is a well-known strategy used by pharmaceutical and medical companies to ensure patient compliance and
follow-through on treatment protocols (Marzban et al., 2022). In addition to the quality of-care outcome, this can significantly impact various treatment decisions (Marzban etal., 2022).

A more tailored and realistic approach to his care was achieved by incorporating the preferences of the patient, social determinants of health, and values. As a result, trust was built, and communication was improved, enhancing his engagement in decision making. In the absence of these factors, patient outcomes would have likely worsened as a result of nonadherence.In addressing chronic conditions through shared decision-making, the patient decision aid I selected played a significant role.

This tool provided precise visual tools for the patient to understand his treatment options and their potential benefits and risks. By utilizing such tools, patients can make informed choices and improve their confidence in managing their health. By participating in this scenario, the patient could actively contribute to the practical aspects of his health care, making it more feasible and sustainable.

In my professional practice, I would use decision aids to facilitate patient-centered care and to empower individuals to participate in their treatment plans. I will apply them to help loved ones understand medical decisions to ensure they are well-informed and actively involved.

References
Chelak, K., & Chakole, S. (2023). The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review. Cureus, 15(1), e33425. https://doi.org/10.7759/cureus.33425

Lee, P. Y., Cheong, A. T., Ghazali, S. S., Rashid, A. A., Ong, S. C., Ong, S. Y., Alip, A., Sylvia, M., Chen, M. F., Taib, N. A., Jaganathan, M., Ng, C. J., & Teo, S. H. (2022). Barriers of and strategies for shared decision-making implementation in the care of metastatic breast cancer: A qualitative study among patients and healthcare professionals in an Asian country. Health expectations : an international journal of public participation in health care and health policy, 25(6), 2837–2850. https://doi.org/10.1111/hex.13590

Marzban, S., Najafi, M., Agolli, A., & Ashrafi, E. (2022). Impact of Patient Engagement on Healthcare Quality: A Scoping Review. Journal of patient experience, 9, 23743735221125439. https://doi.org/10.1177/23743735221125439

Montori, V. M., Ruissen, M. M., Hargraves, I. G., Brito, J. P., & Kunneman, M. (2023). Shared decision-making as a method of care. BMJ evidence-based medicine, 28(4), 213–217. https://doi.org/10.1136/bmjebm-2022-112068

Tenny, S., & Varacallo, M. (2022, October 24). Evidence Based Medicine (EBM).PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470182/

CR Catherine O Richards

initial post

Incorporating Patient Preferences, Social Determinants of Health, and Values in Treatment Planning Situation Description

I met a middle-aged patient who had been diagnosed with Type 2 Diabetes Mellitus (T2DM) and had poor glycemic control. Recurrent hyperglycemia and complications, such as diabetic neuropathy, were reported by the patient in spite of prescription medicines and dietary advice. I started a thorough discussion on a follow-up visit to investigate the possible obstacles causing low adherence.

The patient struggled to follow the recommended eating plan, lived in a food desert with little access to fresh produce, and had severe financial difficulties, it was discovered.

The patient also mentioned that the original treatment plan had not taken into account their choice for meals that were culturally relevant.

Impact of Not Incorporating Preferences, Social Determinants, and Values
The patient’s financial limits, environmental constraints, and cultural dietary preferences were not taken into consideration by the first treatment plan, which focused on a generic low-carb, high-protein diet and the consistent use of expensive diabetic drugs. The patient thus felt excluded from the therapeutic process and found it difficult to pay for the suggested meals. Low adherence, recurrent hyperglycemia, and mental anguish were the results of this gap.

For example, the patient’s meal choices were directly influenced by their inability to afford fresh vegetables or lean protein sources, and their willingness to stick to the plan was decreased when culturally valued items were excluded (Mendes et al., 2022).

This event made clear how disregarding patient interests and socioeconomic determinants of health might compromise treatment outcomes and undermine confidence in medical professionals.

Incorporating Patient Preferences, Social Determinants, and Values
The treatment team took a more patient-centered approach after reevaluating the circumstances. We worked with a social worker to link the patient to a local food bank that offered reasonably priced and healthful food alternatives. To create a culturally appropriate meal plan that matched the patient’s tastes and budget, a dietician was contacted. The plan would use locally sourced products.

For example, in order to satisfy the patient’s demand for specific traditional grains, high-glycemic choices were replaced with comparable ones that had a lower glycemic index, including sorghum and millet. Furthermore, the updated plan featured economical meal preparation techniques and dishes, which made adherence easier (Simmons & Wenzel, 2023). The patient’s glycemic control considerably improved over the course of the next three months, as seen by a lower HbA1c level and fewer problems from diabetes. This strategy emphasized how crucial individualized treatment is to enhancing therapeutic results.

Potential Impact on the Trajectory of the Situation
The incorporation of patient preferences, socioeconomic determinants of health, and values in the treatment plan altered the course of therapy. By removing the financial and environmental constraints, the patient felt less stressed and more confident in managing their disease. The culturally adapted approach improved adherence while also reinforcing a sense of respect and understanding between the patient and the healthcare staff.

This collaborative approach built trust, enhanced the therapeutic relationship, and allowed the patient to have an active part in their own health management. Furthermore, treating these issues early on may avoid future difficulties, lower healthcare expenditures, and enhance overall quality of life (Egede et al., 2023).

Value of the Patient Decision Aid
The Diabetes Decision Aid (Agency for Healthcare Research and Quality [AHRQ], 2022) was an important tool in this scenario. It offered an organized framework for addressing various therapy alternatives, including their advantages, disadvantages, and potential influence on the patient’s lifestyle. Visual aids and interactive elements assisted the patient in weighing the benefits and drawbacks of various dietary and pharmaceutical changes, allowing them to make more educated decisions. By connecting the care plan with the patient’s interests and values, the decision aid increased engagement and adherence.

Application in Professional Practice
In my professional practice, decision aids like these will be extremely useful in encouraging joint decision-making, particularly when managing chronic diseases.
These tools serve to bridge the gap between medical knowledge and patient values, ensuring that treatment plans are both evidence-based and individualized. They may also be used to teach patients the value of addressing socioeconomic determinants of health and adapting interventions to their specific needs. On a personal level, decision aids can help me, or my loved ones make challenging health decisions that are educated and value driven.

To summarize, including patient preferences, social determinants of health (SDOH), and values into treatment planning is critical for obtaining optimal health outcomes, especially when managing chronic diseases. The reported example indicates how disregarding these aspects can lead to treatment failure, whereas including them promotes adherence, trust, and increased quality of life. Healthcare practitioners may provide more individualized and effective treatment by recognizing and overcoming hurdles such as budgetary limits, environmental limitations, and cultural factors. The use of decision aids, such as the Diabetes Decision Aid, improves collaborative decision-making and ensures that treatment regimens are consistent with patients’
values and circumstances.

Finally, incorporating patient-centered methods and utilizing tools such as decision aids enables healthcare workers to better fulfill the different requirements of their patients, resulting in improved clinical results and higher satisfaction with care. These principles not only improve professional practice but also lay the groundwork for compassionate, egalitarian, and efficient healthcare.

References
Agency for Healthcare Research and Quality. (2022). Patient decision aids: Diabetes. Retrieved from https://www.ahrq.gov

Egede, L. E., Walker, R. J., & Campbell, J. A. (2023). Social determinants of health and diabetes outcomes: A review. Diabetes Research and Clinical Practice, 198, 110583. https://doi.org/10.1016/j.diabres.2023.110583

Mendes, R., Sousa, H., & Monteiro, L. (2022). Barriers to dietary adherence in Type 2 diabetes: Financial and cultural perspectives. Journal of Diabetes Nursing, 26(4), 123–130. https://doi.org/10.1002/jdn.2022

Morse, A. L., & Spratt, S. E. (2023). Addressing social determinants of health to improve diabetes outcomes. Clinical Diabetes, 41(1), 18–27. https://doi.org/10.2337/cd22-0054

Simmons, D., & Wenzel, C. (2023). The role of cultural tailoring in diabetes management: Evidence and implications. Diabetes Therapy, 14(2), 245–257.
https://doi.org/10.1007/s13300-023-01356-7

Taylor, L. A., Tan, A. X., & Coyle, C. E. (2023). Incorporating patient-centered care in chronic disease management: A focus on social determinants. Health Affairs, 42(3), 456–464. https://doi.org/10.1377/hlthaff.2023.01234

MM Mariah Mapp

Situation Description

During my clinical rotation in a primary care setting, I encountered a 68-year-old male patient, “Mr. J,” who was managing Type 2 Diabetes Mellitus and had recently developed complications related to neuropathy. Mr. J was presented with the option of initiating insulin therapy due to poorly controlled blood glucose levels. However, the discussion primarily centered around the clinical evidence supporting insulin therapy and did not adequately incorporate his preferences, values, or the social determinants of health affecting his decision-making.

Mr. J expressed concerns about the cost of insulin, as he was retired with limited financial resources. He also shared fears about managing injections due to his mild tremors. Despite these concerns, the clinician recommended starting insulin without further exploring alternatives or addressing his worries. This was a missed opportunity to consider his unique circumstances and involve him in the decision-making process.

Mr. J hesitated to adhere to the treatment plan, and subsequent follow-ups revealed worsening glucose control.

Impact of Incorporating Social Determinants of Health, Preferences, and Values
The provider’s failure to consider Mr. J’s financial and physical challenges significantly impacted his treatment outcomes. Had the provider incorporated social determinants of health, such as economic stability and health literacy, the trajectory of Mr. J’s condition might have improved. By exploring alternative treatment options (e.g., oral medications or assistance programs for insulin affordability) and addressing his fear of injections through education or caregiver support, the plan could have aligned better with his circumstances and values.

For example:
• Economic Stability: Discussing cost-effective insulin options or connecting him with patient assistance programs could have alleviated his financial concerns.
• Physical Limitations: Recommending insulin pens or caregiver support might have addressed his fears about injections.
• Patient Preferences: Exploring non-insulin options or shared decision-making tools could have empowered him to feel more involved in his care. Empowering patients to make informed decisions about their health is a crucial aspect of patient-centered care.

Value of the Decision Aid
I reviewed the Ottawa Hospital Research Institute’s decision aid inventory and selected the “Diabetes—Starting Insulin” decision aid. This tool, which is a comprehensive guide, provides patients with clear, evidence-based information about the benefits, risks, and alternatives to starting insulin therapy, and it includes prompts to evaluate their values and preferences.

This decision aid could have contributed to more effective decision-making in Mr. J’s case by:
• Facilitating a structured discussion about his priorities (e.g., avoiding hospitalization and cost concerns).
• Helping him weigh the pros and cons of different treatment options in a way that aligned with his values.
• Empowering him with information to participate actively in the decision-making process.

Application in Professional Practice
The Ottawa Decision Aid Inventory is a valuable resource in professional practice for fostering shared decision-making. I would incorporate these tools during consultations to:
1. Provide patients with tailored information about their condition and treatment options.
2. Guide discussions that explore their values, preferences, and concerns.
3. Enhance patient satisfaction and adherence by involving them in decision-making.

In my personal practice, I aim to use decision aids to address the social determinants of health more proactively, ensuring that care plans reflect not only clinical evidence but also each patient’s unique context.

Conclusion
Incorporating patient preferences, values, and social determinants of health into treatment planning can significantly improve patient outcomes and satisfaction.
Decision aids, such as those provided by the Ottawa Hospital Research Institute, are essential to achieve this by facilitating structured, patient-centered discussions. In Mr. J’s case, a decision aid could have bridged the gap between his concerns about the cost of insulin and his fear of injections, and the recommended treatment, potentially leading to better adherence and improved health outcomes