Peer answers- patient preferences and decision making

Peer 1

Susannah Beier 

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While I am fully supportive of incorporating patient preferences and values in their treatment plan, I also know from a medical standpoint that it is not always in the best interest of the patient. Throughout my years in medicine, I have witnessed many occasions where the patient arrived in labor and delivery with a very detailed birthing plan.

For example, I had a patient bring in a 4-page birthing plan with every little detail, including the essential oils she wanted to use during each phase of labor, music she wanted to play, noise level, refusal of a cesarean section, etc. Of course, this patient failed to progress and wound up with an emergency cesarean section causing the patient to have negative feelings about the birthing process and the labor and delivery staff. “Findings showed that women relied on many resources when planning a birth and that changes made to a woman’s initial birth plan affected her recollection of the birth experience” (Cook & Loomis, 2012, p.158). 

I think that it is fine for a patient to verbalize their preferences and values; however, it is important for them to be realistic about the fluidity of medicine, especially during labor. The patient’s preferences and values impacted the trajectory of the situation because she wasn’t willing to accept the doctor’s recommendation to perform a cesarean section. The doctor had informed the patient that she was not progressing as expected, but she refused to accept a c/s and was focused on fulfilling her birthing plan. “During both the development and implementation of the birth plan, women must negotiate their expectations and make health decisions with their care providers” (Cook & Loomis, 2012, p. 160). Had the patient accepted a c/s earlier on and realized that it was medically necessary, some of her preferences might have been fulfilled; however, since she refused a c/s until it became an absolute emergency, her preferences were no longer able to be incorporated.

“Patient decision aids (PDAs) have been developed as a way to support patient participation in the decision-making process and to increase the likelihood of reaching a treatment decision that is both clinically sound and in line with patients’ values” (Ankolekar et al., 2018, p. 3). The patient decision aids on childbirth can help the patient make an informed and realistic decision about birth choices, pain management during labor, and spontaneous or induced labor (The Ottawa Hospital Research Institute, 2019). Using the decision aid inventory in my professional practice or personal life could be very helpful as it provides balanced information on a wide variety of topics and