Tina Matthews-Hayes, BSN, MSN, DNP, FNP, PMHNP and Jessica Whelan, DNP, MSN, BA, FPMHNP discuss the importance of looking at things from a patient's perspective and identifying the outcomes that are valued most by patients.
TMH: Hi everyone. I’m Tina Matthews-Hayes.
JW: And I’m Jessica Whelan. Tina and I are both practicing NPs, and one of the unique things that NPs bring to the table in our practices is the ability to see the whole patient. In psychiatry, it is so important to recognize that people are multi-faceted, and there is no typical one patient. Perspectives, backgrounds, values, and home lives are going to differ for everyone. And all of these factors inform how the patient is going to view their diagnosis, how they will respond to treatment, and what they will consider as positive outcomes of their personal treatment.
TMH: Jess, That’s absolutely right. Positive outcomes may look different across patients. For example, a positive outcome may be functional like improved work performance, or clinical such as improving or resolving physical symptoms. We’ll talk about some of the outcomes in terms of overall wellness in just a bit.
JW: So Tina, how do you in your practice know what is most important to the patient?
TMH: Jess, we have talked about this a lot. We both believe in using a shared decision-making model that involves patients in their treatment will help achieve better outcomes. The ability to reach wellness and improve quality of life for our patients is particularlly dependent on a patient feeling seen and heard, so there is a need to establish trusting relationship with our patients. When talking about preferences, patients need to be clearly informed of their options, in order to have those choices.
JW: Yes. 100%. Tina, I think want to expand on this. Patients deserve to be educated on their available options and to be part of their treatment plan. Educating patients upfront and giving them the access to information can actually help avoid surprises, reduce fears, and lead to more buy-in on their treatment plans. Giving patients autonomy to help make decisions about their treatment is so incredibly important.
TMH: You know Jess, I think we both do this—I always talk to my patients and fully explain medication and mechanism of action and ask patients about their concerns. So I say “Here are the positives and negatives. Here are the options. What do you think? And here’s what I would suggest.” And we come to a decision together.
JW: Definitely. You want to touch on outcomes, and overall wellness, and then highlight factors that can impact patients specific outcomes.
TMH: Absolutely Jess. When we talk about wellness, I think sometimes we are missing holistic wellness. The litmus test for stability unfortunately is very low. We don’t want the high highs and we don’t want low lows, but are we asking our patients: “Are you enjoying your life? Do you feel like you have quality days?” I always keep in mind, that we may be making treatment decisions that can cause other potential long-term issues for physical wellness. We can manage depression but we need to consider side effects, such as weight gain, diabetes, or sleeping excessively. These cause other concerns. Patients deserve better care than that. Holistic wellness is something that can be overlooked by some healthcare providers.
JW: I would agree with that. Side effects can definitely impact how patients view outcomes. Other factors that may impact clinical and functional outcomes in addition to their quality of life include the stigma around mental health. Undoing stigma around mental health, and going back to that education component, is so important. For example, you could let your patients with bipolar disorder know that with well-managed disease, they can lead more successful, “normal” lives.
TMH: Absolutely. Jess, and I think reinforcing continuing education, while mandatory for our licenses, is a very important part for our providers to engage and participate in. Always asking “Can we be using better option, or newer options that will improve patient outcomes?”
JW: Definitiey. And I understand that access to care differs for patients and this can also impact outcomes. In the United State, there are healthcare disparities in the provider landscape. We see this geographically across the United States. As an example, the Midwest has much poorer access to diverse services than say the coast. A California treatment center may include “yoga” as a basic norm in every program, whereas in the Midwest it is considered a “luxury”.
JW: And then, because of the COVID-19 pandemic, in some ways there has been a positive shift to the utilization of more telemedicine. This has been able to help expand the access to care, but you must be prepared to educate your patients on the challenges of adapting this technology.
I always tell them that social support, having a network of people that can help patients, can be the difference between achieving wellness or not, and does the patient have this? Moving into the future I think we really need to be taking measures to implement more community support as well.
TMH: Jess, I think that’s a great segue to talking about: we must respect sociological, cultural backgrounds and that individual patient’s views on mental health and how healthcare will differ with every patient we talk to. Learning about the patient’s individual beliefs and how their views will effect their treatment, and subsequent outcomes, impacts the shared decision-making model that we talked about before.
JW: I think that based on both our experiences, Tina and I want to share some real-world tips on how to identify and address patient’s values and perspective on outcomes in practice:
TMH: Absolutely. So number one in my book, I think in both of our books is having an open, honest discussion and building a trusting relationship with the patient. I encourage patients to read through any information I give them, but I also let them know I’m here, I’m paying attention, I’m going to support them, and we’ll manage it together. I say to patients: “If you don’t like how you feel, we’ll find another option.” If patients don’t feel like you have their best interest at heart, it’s not going to be a successful relationship. Keep in mind that building the relationship can take a few appointments. It doesn’t usually happen overnight. Autonomy and involvement in decision-making can increase compliance and help with overall outcomes.
JW: Definitely, and then I would say number 2 is to set realistic and obtainable goals. There will still be low periods, but are they as low as before? Identifying downward trends and changing behavior to try and avoid the extreme lows, that’s what is imperative.
TMH: Number 3 would be identifying key support people in the patient’s life, whos is the support people I ntheir lives? This often involves educating family. You need the support system to understand nobody chooses to be bipolar; it’s just a dopamine dysregulation. So we can work with you, have a treatment plan in place, and have support systems in place to mitigate any of those behaviors that you’d mentioned.
JW: Definitely. I tell my patients having a support person who can help you see the lows and can help reinforce positive coping systems can be very helpful. And I’d also say don’t discount the benefits of remote patient monitoring, which is something I love using, and the use of technology in practice can be especially helpful, definitely in telemedicine. There are newer technologies out there that can help patients log how they are feeling and any symptoms they are experiencing, and this just means providers are going to be even better informed.
TMH: Jess that’s a great point and something I think we can all work a little bit better to understand and gain insight into. But to wrap up, patient values are such an important consideration in how a patient will feel about the outcomes of their treatment. Patients need to be accurately informed of what options are available to them and have their preferences heard in order to make informed decisions in their care process.
JW: As Nurse Practitioners, we have the opportunity here to guide our patients through their illness and to help improve their quality of life and care by focusing on what outcomes they value and what impacts their lives the most.
JW: I want to than you all for joining us today and Tina, it’s been son wonderful being able to talk with you and powwow today.
TMH: Absolutely Jess. It’s always a pleasure and also I’d like to thank everyone who took the time out to listen to us today.