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 illustrates 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

• 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

• Cultural and religious preferences
  • e.g. Kosher or halal food only
  • e.g. Disallow blood transfusion
  • e.g. Vegetarian diet

• Personal taste preferences
  • Patient satisfaction
  • Diet preferences (vegetarian)
  • Personal reason
    • Affordability of care (for this there may be an associated Care Barrier which could potentially be addressed by a care manager finding programs for which the patient is qualified)

• Communication preferences
  • e.g. Always talk with the daughter
    • Eliminate frustration so daughter does not have to repeat every time
    • Bad relationship with son so avoid this communication
  • e.g. 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)

Care Preference

---

preference : Code

effectiveDate : DateTime

expressedBy : Role

strength : Level

media: URL[0..*]

activationCriteria: Criterion[0..*]

alternatePreferences : CarePreference[0..*] {ordered}

Attribute Definitions: Care Preference

---

preference : Code	A code which specifies the type of the patient preferenceneed some concrete examples to drive vocabulary requirements
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	The strength of the preference (High or Low).
comment : Note	A note 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..*]	A criterial specifying how the preference is to be activated (this needs work and some examples)
alternatePreferences : CarePreference[0..*] {ordered}	A list of ordered alternate preferences acceptable to the patient or caretaker in case the primary preference cannot be fullfilled

Class Associatons

• 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 HealthActivity or Intervention.

Plan	----------carePreferences [0..*]--	Care Preference
		[0..*] activityPreferences | | | |
	----------interventions[0..*]--	CareActivity