Care Preference

Overview

A care preference is a statement expressed by the patient, custodian or caretaker responsible for the patient in order to influence how their care is delivered.

A preference expresses a personal choice and may be driven by cultural, religious and moral principles. As such it is a principal component of patient centered care and autonomy. Care preferences serve as modifiers of the Care Plan which influence how the plan is personalized for the individual.

A care preference may be specified prospectively to influence future care planning and treatment or it may be expressed and recorded at arbitrary decision points during interventions.

A preference expresses a request to fulfill a patient's choice or desire. The choice may be a strong and absolute statement such as an end of life directive. The request could also be a desire to be fulfilled if possible given care team capabilities and resources.

Examples

The following examples illustrate major categories of preferences in order to test usability and completeness of the model.

Treatment preferences

• e.g. Choice to use certain medications
  • e.g. patient refuses based on his or her risk assessment of side effects
  • e.g. patient requests lower dose due to how they feel after taking a medication cocktail
• e.g. Choice of surgical procedures
  • e.g. patient does not want invasive procedures performed
• e.g. Oncology therapy
  • e.g. an informed patient selects a given therapy based on a list of considered alternatives
• e.g. Disallow blood transfusion

End of life preferences

• Patient does not want to live in a vegetative state
  • e.g. No respirators should be applied
  • e.g. Patient rejects tube feeding
  • e.g. No resuscitation should be applied

Other Personal Preference

• Patient satisfaction
• Diet preferences
  • e.g. vegetarian
  • e.g. Kosher or halal food only
• Affordability of care
  • for this example there may be a Care Barrier as well used to track, managed and support finding assistance for the patient

Communication preferences

• e.g. Patient asks that care givers always speak with the daughter
  • Eliminate frustration so daughter does not have to repeat every time
  • Bad relationship with son so avoid this communication
• e.g. Patient specifies preferred email and phone

Class Definition

Note:

1. The preference code may be a natural code (e.g. simple string) in the absence of a defined vocabulary.
2. Vocabulary for preferences needs to be defined
3. Model does not include common information management attributes (e.g. preference record create time, update time). It only includes descriptive attributes of the domain.

Care Preference

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preference : Code	A descriptive code which specifies the type of the patient preference (need some concrete examples to drive vocabulary requirements) Example vocabulary values: ...
reason : Code[0..*]	Captures a reason indicator for the preference. The reason may be classified as cultural, religious, moral/ethical (others?). The reason is a factor which should already be included in considering the strength of the preference. It is explicitly indicated in the model in order to provide context for handling with sensibility.
effectiveDate : DateTime	The date/time the preference becomes effective for consideration when providing care
expressedBy : Role	The individual who expressed the preference. This is typically the patient but it may also be the patient's caretaker (for a young child or a patient who is not able to decide for themselves)
strength : Level Type	The strength indicates flexibility in the interpretation of the patient's choice by the care team participants. The strength may be High and indicate an absolute choice driven by moral principles, cultural or religious principles. Or it may indicate an important desire which the patient has but for which the patient has flexibility. The strength may have a value of either High or Low. Absolute_Choice and Desired_Choice may reflect the intent better
notes : Note[0..*]	Optional notes about the preference. The note captures a text narrative, date of the note and the individual making the note.
media: URL[0..*]	Optional link to external documentation supporting the preference (e.g. scanned advence directive or legal documents on file)
activationCriteria: Criterion[0..*]	Specifies how the preference is matched to an Intervention and the conditions under which it is activated (this needs work and some examples)
alternatePreferences : Care Preference[0..*] {ordered}	A list of ordered alternate preferences acceptable to the patient or caretaker in case the primary preference cannot be fullfilled. The ordering indicates the next best alternative for the patient.
acceptance: Acceptance Review[0..*]	Captures acceptance or acknowledgement of the preference by one or more care team members. Acceptance represents alignment of the patient and providers understanding.
unfulfilledReason: Reason[0..1]	Captures the reason why a preference cannot be applied during an intervention in which the preference should apply. This property can only be set for preferences associated with a Health Activity

Class Associations

• A proactive use of preferences defined by the patient or patient's caretaker is linked directly to the "Plan"
• A reactive preference determined as a reaction to proposed plan interventions is directly linked to the Health Activity or Intervention.

Care Plan	--------- carePreferences [0..*] --	Care Preference
		[0..*] activityPreferenceModifier | | | |
	--------------- interventions[0..*] --	Care Activity

Class Instances for validation

TODO

preference	reason	effectiveDate	expressedBy	strength	notes	media	activationCriteria	alternatePreferences	acceptance	unfulfilledReason
-	-	-	-	-	-	-	-	-	-	-