Strategies For Making Patient Priorities Aligned Decisions
Strategy: Use patients’ health priorities as focus of communication and decision-making
Patients will feel listened to and be more motivated to follow through with healthcare recommendations while giving clinicians an anchor for decision-making in the face of uncertainty and complexity.
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Scripts
Acknowledge what matters most:
“There are different things that we could do. But knowing your illnesses, your overall health, and what matters most to you, I suggest we try (fill in intervention).”
Invite discussion on interventions:
“Is it ok if I share with you how (fill in intervention) may impact your goal of (fill in health outcome goals)?”
Frame data for acute interventions around health priorities:
“Let’s talk about why I think this (fill in intervention) might help you with your goal of (fill in health outcome goals). From what we know from people like yourself who have undergone (fill in procedure), the most likely outcome is that (fill in most likely outcome).”
Base chronic therapy on health priorities:
“I know that (fill in health outcome goals) is important to you, I think of (medication and/or intervention) is (are) most likely to help you achieve that”.
Scenario
Patient doesn’t want to take diuretic.
“I know you want to be able volunteer at the library and you find the torsemide difficult because you have to urinate a lot. Let’s try dietary measures and limit the amount of fluid you drink to see if we can decrease the dose of torsemide you need to take. Keeping fluid off of your body will make you less short of breath to help you do things with your grandkids “
Future trials include: (1) switch to every other day dosing on the torsemide (2) take torsemide only on days when not volunteering (2) switch to a shorter acting diuretic once a day
Scenario
Thinks medications are causing falls.
“I know that you think your medications are causing you to fall which is keeping you from volunteering at the library. Let’s start to help you achieve your goal to volunteer more by discontinuing one of the blood pressure medications that may be contributing to your falls.”
Future trials include: (1) PT evaluation to identify if there are any balance or gait problems and they can give you a home exercise program. (2) Informational print out about improving home safety (3) explore barriers to adherence with assistive walking devices
Scripts
Direct symptom-focus onto desired activities:
“Your health outcome goal is to improve (symptom) so that you can (health outcome goal). Let’s discuss changes to your healthcare that can help you do that.”
Collaborate on addressing bothersome symptoms:
“We can work together to help you achieve your health outcome goal over time.”
Scenario
Patient focused on unrelieved pain.
“You have said that your arthritis pain is getting in the way of you volunteering. While we may not be able to get rid of the pain completely, let’s talk about what we can do to get you back to volunteering. We can start by using a combination of patches and scheduled acetaminophen.”
Future trials include: physical therapy such as ultrasound and specific exercises, changing frequency or dose of oral therapy, changing class of oral therapy, injection therapies, wraps, heat or cold treatments and topicals
Scenario
Patient reports bothersome side effect of increased urination with diuretic use
“We can work together to help you achieve your goal to volunteer more at the library by identifying ways to decrease the frequency of urination that you experience during your time at the library.”
Future trials include: (1) Timed voiding, (2) changing the type of diuretic to shorter acting, (3) fluid restriction
Direct symptom-focus onto desired activities:
“Your health outcome goal is to improve (symptom) so that you can (health outcome goal). Let’s discuss changes to your healthcare that can help you do that.”
Scenario
Successful trial
“I understand you’re still having some pain but that you are back to volunteering. I’m so glad you are back to doing what matters most to you”.
Scenario
Unsuccessful trial
“I know we reduced your diuretic because you wanted to have less urinary frequency, but it caused more shortness of breath and now you can’t volunteer. Let’s try taking the higher dose in the evenings on days when you go to the library so you urinate less during the day.”
Future trials include: (1) Timed voiding, (2) changing the type or frequency of diuretic (3) adding a potentiator to a dose such as metolazone (4) addressing barriers to fluid restriction adherence such as sugar free lozenge for dry mouth.