Overview
Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences, and social determinant of health, 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. Find your own scenario to come up with but you can imitate this sample ( it is from my classmate . ) I am a nurse so find a scenario related to nursing -patient care
Discussion: Patient Preferences and Decision Making
The Situation
While working as a nurse in a cardiothoracic intensive care unit, I cared for a man in his late sixties who developed new-onset atrial fibrillation on postoperative day three following coronary artery bypass grafting. Because his rhythm did not convert, the team initiated anticoagulation for stroke prevention. The choice of agent was made during rounds in under five minutes: warfarin was selected because the direct oral anticoagulant carried a high copay under his insurance. The patient was told what he would be taking rather than asked what he could realistically manage. He nodded, and the plan moved forward.
Impact of Omitting Preferences, Values, and Social Determinants
What the team did not ask about proved to be important. He worked an hourly delivery route with no paid time off and lived roughly an hour from the nearest anticoagulation clinic without reliable transportation, placing barriers in both the economic stability and health care access domains of social determinants of health (U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, n.d.). His reading level was limited, and he obtained much of his food from a local pantry, which made the consistent dietary vitamin K intake that warfarin requires nearly impossible to maintain. His central value, which surfaced only later, was returning to work and remaining independent; weekly laboratory monitoring conflicted directly with that goal. He discontinued the medication within several weeks and returned to the emergency department in rapid ventricular response with a subtherapeutic INR. The decision was evidence-based, but it was not implementable within his life circumstances. This is precisely the failure Hoffmann et al. (2014) describe when evidence is applied to a patient without shared decision making.
How Inclusion Would Have Changed the Trajectory
Had the patient’s preferences, values, and social determinants been incorporated, the conversation would have begun with what he could sustain rather than with what the formulary preferred. A pharmacy consultation could have pursued manufacturer patient-assistance funding for the direct oral anticoagulant, social work could have addressed transportation, and point-of-care self-testing or a telehealth anticoagulation visit could have replaced the clinic trips. The treatment plan would have reflected these considerations concretely through a documented barriers-and-values assessment in the discharge summary, teach-back education matched to his health literacy, and a named follow-up contact within one week. The probable trajectory is sustained anticoagulation and stroke prevention rather than abrupt discontinuation and readmission.
The Selected Decision Aid
From the Ottawa Hospital Research Institute (n.d.) A to Z Inventory of Patient Decision Aids, I selected the American College of Cardiology's decision aid for atrial fibrillation stroke prevention. The tool makes the decision explicit, displays absolute stroke and bleeding risk visually rather than as isolated percentages, presents the options side by side, and includes a values-clarification step. Its general value is well established. In a Cochrane review of 209 randomized trials involving 107,698 participants, patient decision aids improved knowledge and accuracy of risk perception, reduced decisional conflict, and increased the proportion of patients who took an active role in the decision (Stacey et al., 2024). In the situation described above, the aid would have created the deliberate pause that rounds did not allow, framed monitoring burden as an explicit trade-off rather than an administrative detail, and made his hesitation visible while he was still hospitalized and the plan could still be changed.
Using the Inventory in Practice
I plan to keep the Ottawa inventory bookmarked and to consult it before discharge teaching on any preference-sensitive decision, since it is free, curated, and organized by condition. As I move into primary care through my graduate program, I intend to identify aids for the decisions I will encounter most frequently, including anticoagulation, statin initiation, and cancer screening, and to embed links to them in the visit workflow so the aid is available at the point of decision rather than afterward. Personally, I have also found the inventory useful for helping family members formulate questions before an appointment instead of after it.
References
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. https://doi.org/10.1001/jama.2014.10186