From the Guidelines
When a patient with impaired understanding expresses difficulty comprehending their treatment plan, the most appropriate response is to assess the patient's understanding of their disease status, prognosis, and treatment preferences, and involve family members if necessary, as this approach respects the patient's autonomy and ensures proper communication. This approach is supported by the American Society of Clinical Oncology consensus guideline 1, which emphasizes the importance of assessing the patient's understanding of their disease status, prognosis, and treatment preferences, as well as their goals of care and treatment preferences. The guideline also suggests determining whether the patient is prepared for explicit information, is ambivalent, or does not want information, and negotiating a future discussion or discussion with family members if necessary. Involving family members can help bridge communication gaps, provide emotional support, and improve treatment adherence, as noted in the European Society of Cardiology Heart Failure Association position paper 1. Some key strategies for effective communication include:
- Establishing a rapport and supportive relationship with the patient and family
- Exploring the patient's general thoughts about preferences and expectations for treatment and care
- Clarifying prognosis in a direct yet caring manner
- Identifying goals and facilitating open discussion about desired treatment and care
- Developing a treatment plan that takes into account the patient's preferences and values. By following these strategies, healthcare professionals can provide high-quality care that respects the patient's autonomy and promotes effective communication.
From the Research
Understanding the Patient's Concerns
- The patient's statement 'what nonsense are you talking, I can't understand a thing' indicates a lack of understanding of their treatment plan, which may be due to impaired understanding or cognitive impairment 2.
- It is essential to assess the patient's capacity to make decisions about their treatment, taking into account their vulnerability and potential lack of understanding 3, 2.
Addressing the Patient's Concerns
- Nurses should evaluate the patient's concerns and determine the appropriate response, considering the potential effect of the concern on the patient and involving other team members if necessary 4.
- The patient's autonomy and right to make their own healthcare decisions should be respected, while also ensuring that their safety and well-being are prioritized 3, 5.
- In cases where the patient's understanding is impaired, it may be necessary to involve family members or other stakeholders in the decision-making process, while still respecting the patient's autonomy and wishes 3, 6.
Not Being Suicidal (NBS) Considerations
- There is no direct evidence in the provided studies that specifically addresses the concept of Not Being Suicidal (NBS) in relation to the patient's statement and treatment plan.
- However, the studies emphasize the importance of respecting the patient's autonomy, assessing their capacity to make decisions, and prioritizing their safety and well-being, which may be relevant to NBS considerations 3, 4, 2.