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Decision Support for Patient Preference-based Care Planning

Effects on Nursing Care and Patient Outcomes

Case Western Reserve University, Cleveland, Ohio. Dr. Ruland is now with the Institute of Nursing Science, University of Oslo, Norway.

Corresdpondence and reprints: Cornelia M. Ruland, RN, PhD, Institute of Nursing Science, University of Oslo, P.b. 1120 Blindern, 0317 Oslo, Norway. e-mail: <ruland{at}online.no >.

Received for publication: 12/28/98; accepted for publication: 03/11/99.

Objective: While preference elicitation techniques have been effective in helping patients make decisions consistent with their preferences, little is known about whether information about patient preferences affects clinicians in clinical decision making and improves patient outcomes. The purpose of this study was to evaluate a decision support system for eliciting elderly patients' preferences for self-care capability and providing this information to nurses in clinical practice—specifically, its effect on nurses' care priorities and the patient outcomes of preference achievement and patient satisfaction.

Design: Three-group quasi-experimental design with one experimental and two control groups (N = 151). In the experimental group computer-processed information about individual patient's preferences was placed in patients' charts to be used for care planning.

Results: Information about patient preferences changed nurses' care priorities to be more consistent with patient preferences and improved patients' preference achievement and physical functioning. Further, higher consistency between patient preferences and nurses' care priorities was associated with higher preference achievement, and higher preference achievement with greater patient satisfaction.

Conclusion: This study demonstrated that decision support for eliciting patient preferences and including them in nursing care planning is an effective and feasible strategy for improving nursing care and patient outcomes.

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