Helping Patients Choose

In this era of rapid change in American medicine, with increasing demand from consumers for transparency in health care, who should help patients make treatment decisions based on unbiased information and an overarching concern for patient well-being?

Nurse case managers provide an important function in evaluating, coordinating and facilitating appropriate care for workers injured on the job. Another critical aspect of their role involves educating injured workers about their diagnosis, prognosis, and treatment options, as well as establishing positive expectations for recovery and return to work.

Many injured workers have a poor understanding of their diagnosis and its clinical implications, and this lack of knowledge frequently leads to confusion and fear. Injured workers rarely ask the important questions related to anticipated outcomes, treatment alternatives, and treatment risks. And because injured workers do not have out-of-pocket costs, they are less likely to weigh the costs and benefits of expensive procedures in relationship to other effective but less costly treatments.

As patient advocates and care coordinators, nurse case managers can enhance health outcomes for injured workers by enhancing education and shared decision-making.

In healthcare, shared decision making is the process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values. Unfortunately, shared decision making is not the norm in the American medical community. Patients sometimes receive care based less on their values and preferences, but more on their physicians’ payment incentives.

Skilled nurse case managers can help break through the potential financial biases of treating providers by doing what they do best: obtaining patient engagement and helping the patient make sense of the information from the treating provider.

Since 2002, the annual Gallup poll ranking of honesty and ethics in various fields have ranked nurses the most trusted profession in America.

Telephonic nurse case management is an effective way to obtain patient engagement in workers’ compensation. To successfully facilitate care coordination, ensure patient safety and achieve quality health outcomes, nurses must be aware of individual factors affecting treatment choices. Educating a patient on treatment options involves enhanced communication skills and an awareness of leading medical technology. It also requires tailored planning and an evaluation of care that respects patient diversity and takes into account cultural, religious, psychological, social and economic factors.

Nurse case managers should utilize comprehensive, system-integrated tools and applications to enhance patient involvement and promote SDM between the patient and treating physician. Some of these clinical aids include:

  • Biopsychosocial assessments, functional assessments, pain assessments and pain diagrams
  • Online and print resources for patient education on the work-related injury and co-morbid conditions , such as smoking cessation information
  • Injury management tools, such as core treatment plans, pre- and post-op surgery planning checklists, patient letters, pre-operative and psychological surgery education

Ongoing and collaborative communication between the nurse case manager and the patient builds mutual trust, respect and confidence — each one an essential component in the nurse-patient relationship. Cooperative communication encourages the patient to be a more proactive participant in treatment choices and the decision-making process. This supportive relationship fosters patient satisfaction and compliance with the care plan, and can shorten recovery time and disability duration.

Many injured workers have a poor understanding of their diagnosis and its clinical implications. This lack of knowledge can lead to confusion and fear. How many patients, for example, fully understand the clinical implications of a bulging disk or an annular tear? These findings on an MRI can be interpreted by the patient as a dire medical consequence, something that requires immediate, invasive treatment, when it is actually a routine finding in asymptomatic individuals. A patient’s mistaken beliefs can lead to a cascade of unnecessary medical interventions and exaggerated disability.

Nurse case managers often have considerable firsthand experience of the benefits and burdens associated with various treatment choices and can help injured workers find and understand information regarding treatment outcomes so they can compare treatment alternatives.