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Making Informed Decisions:

A Unit in Healthcare Decision Making for a High School Mathematics Classroom

Brittany Bowling, Brianna Castrogiovanni, Bree Smith, and Nikole Travis

Department of Curriculum and Instruction, Purdue University

EDCI 54800: Teaching Math to Diverse Learners

Andrea Leahy

October 17, 2021

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Making Informed Decisions: A Unit in Healthcare Decision Making for a High School

Mathematics Classroom

Social justice is a topic that is recently gaining attention in an educational setting. Though

this term has been around for quite some time, schools, administrators, and teachers nationwide

are beginning to understand the importance of teaching social justice within the classroom. The

National Education Association (2018), defines social justice as, “...not just the absence of

discrimination but also the presence of values and systems that ensure fairness and justice” (para.

4). Within a classroom setting, social justice has a variety of ways in which to be easily

embedded in daily lessons; however, at the core, social justice in education is twofold. First, it is

ensuring that social justice is being upheld within one's lessons. This means that all lessons are

accessible to every learner, regardless of any individual differences. In addition, social justice in

education can also refer to the teaching and addressment of social justice issues that students

may face.

The first aforementioned implementation of social justice is ensuring that lessons are

upholding social justice. Better known to most, ensuring one’s lessons are upholding the values

of social justice is very much connected to creating lessons that are equitable. It is well known

and recognized that students are diverse in nature. They come from different backgrounds,

different races, different religions, different beliefs, different financial situations, just to name a

few. When a teacher is able to recognize the uniqueness that each student brings to the classroom

and use this to better enhance their classroom dynamic, they are doing their part in ensuring the

values of social justice are being upheld. A teacher must not let these individual differences

hinder the opportunity for achievement that a student is given.

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In addition, social justice is a topic of vast importance, as it can serve as a pathway to

being informed. This is the second mentioned implementation of social justice. Social justice is

the bridge that connects those in difficult situations with the information they need to act and

proceed accordingly and in their best interest. Gutstein (2007) argues that young adults, “may not

have information about their life situations." Similarly, "adults who are engaged in various

struggles may have community knowledge that is quite critical" (Gustein, 2007, p. 111). In other

words, young adults often do not know how to deal with situations that arise in their lives and it

is typically not until adulthood, when one may become part of a community that shares a

common challenge, that one starts to gain knowledge of said situation.

The need for social justice is quite evident. According to Sapon-Shevin (2003),

“inclusion is about social justice. . . . By embracing inclusion as a model of social justice, we can

create a world fit for all of us” (as cited by Theoharis, 2007, p. 223). Teachers must do

everything in their power to create an inclusive environment, be inclusive in the materials they

select, and refrain from any biases they may have, including those that are unintentional. Many

teachers are graduating with little to no knowledge or training relating to social justice. Jacobsen

(2011) notes "almost no attention has been given thus far to preparing preservice teachers to

teach mathematics for social justice" (p. 558). However, while many may fail to recognize the

need for social justice in the classroom, it is extremely important to consider the challenges or

problems that students may be facing. In addition, if one is not aware of certain situations or

social justice issues, they are not as inclined to help create a solution. As quoted by Frankenstein

(2012), “To respect student knowledge and thus work for justice... it is important to explore

many issues that students might not initially be interested in” (p. 54).
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The Need for Social Justice in Healthcare

Social justice means that everyone deserves equal rights and opportunities - regardless of

race, gender, sexual orientation. This rings true in healthcare where everyone deserves a right to

good, accessible healthcare. According to the American Public Health Association (APHA),

there is quite a discrepancy in the inequality of healthcare for Blacks, Hispanics, and

Asian-Americans (2021). More specifically, “more than 30% of direct medical costs” of these

populations are “tied to health inequalities” (APHA). The APHA has even found that for these

patients that do seek healthcare, their practitioners have an unconscious racial bias toward their

patients which leads to lower care quality and even less communication between physician and

patient. With this, patients are not able to make informed decisions in regard to their healthcare.

It is clear that social justice is lacking in healthcare and that a revamp needs to take over.

Beyond someone’s race, other factors that lead to inequality in regard to access to healthcare

include education, socioeconomic status, or employment. It is the responsibility of healthcare

workers and administrators to understand who is at risk for inequalities in healthcare and

deliberately creates other avenues in order to combat these inequalities. Regis College discusses

that healthcare administrators are the first line of fighting inequalities (2021). These

administrators can do so by training their nurses to become advocates by interceding in defense

of their patients, creating care models that are culturally aware, enhancing access to care by

utilizing virtual care options, and developing a more economic and inclusive budget for their

patients.

For this project, a long-time healthcare worker and a young adult patient were

interviewed regarding their experiences with access to healthcare and how to inform a patient or

be an informed patient. The healthcare worker, Kathy Simon, worked as a registered nurse for 11
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years and has been working as a nurse practitioner for 23 years, totaling 34 years in healthcare.

When asked how she sees the future of healthcare, she responded, “I think healthcare will

continue to be more accessible through the increased usage of telehealth visits. However, I also

see the cost of healthcare continuing to increase.” When asked how Ms. Simon ensures that her

young adult and teenage patients are informed regarding their healthcare, she replied that “I

encourage these age groups to use reputable websites if they are going to use the internet to see

answers to their healthcare questions. I strongly encourage them however to ask a trusted

healthcare professional first. When seeing this age group in the office setting, I would make sure

they understood my instructions and would provide them the opportunities to ask questions and

seek further clarification.” The patient interviewed is a 17-year-old, female, and senior in high

school. She will be referred to as Jamie for the sake of this paper. Since Jamie is on the cusp of

becoming an adult and being responsible for her own healthcare, it was important to gauge her

understanding of what it means to be an informed patient. Jamie knew who her insurance

provider was but not how to determine if a provider is in-network. She also said that she felt

comfortable disclosing all health history information to her provider as well as any new

applicable information regarding her health as issues arise. When asked how she as a patient can

be informed, she said that she would conduct her own research but that she doesn’t always know

how to determine if the information is reputable. She also stated that if need be, she could, “call

her doctor’s office to ask questions and verify the validity of the researched information.”

From these interviews, we found that while access to healthcare seems to be increasing

with telehealth visits or simple phone calls, the cost of healthcare seems to be going up and

reputable healthcare reports are becoming more difficult to find.

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Unit and Lesson Descriptions

This unit is designed to bring together critical, community, and classical knowledge.

Gustein says, “it is often the case that community knowledge already is critical, but context

matters,” (p. 111, 2007). We chose to gear informed decision making in healthcare toward grade

11 because this is when the knowledge is most critical to all of them. Students who are in grade

11 are typically 17 or 18 years old. They have or are about to have the ability to make medical

decisions for themselves without parent/guardian involvement.

Nieto mentions that a social justice approach to curriculum shows students that life is

complicated and there are no easy answers (2003). This is true for our topic. Our unit is designed

to give students the right tools to make informed decisions but there is no right or wrong answer

for which decision they try to make. We will teach them not only what informed decision

making is in health care, but will also allow them the opportunity to practice making informed

decisions by using a variety of statistical approaches. We provide them with data from several

different studies and teach them to evaluate the data using various statistical approaches.

Students will have the opportunity to justify their decisions using statistics and their own logical

reasoning. These lessons will lead to a greater conversation about the inequality in healthcare

due to cost.

Lesson one begins with an introduction regarding informed decision-making in regard to

healthcare. Students learn the difference between informed and shared decision-making and

apply previously learned mathematical concepts - mean, variance, standard-deviation, and t-tests

- in order to make informed decisions regarding data from a medical trial. In this lesson, students

compare endocrine dysfunction in pediatric brain tumor patients. Half of the patients received

traditional radiation and the other half received proton radiotherapy. Students will compare the
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pre- and post-treatment results, find the change of x, determine the mean of the data sample,

calculate the variance of the data as well as the standard-deviation of the data set. After

analyzing both data sets, students will compute a t-test to compare the two sets of data. From this

medical trial, students will find that the experimental group using the proton radiotherapy had

significantly less endocrine dysfunction than the experimental group using traditional radiation

treatment.

Lesson two is about using conditional probability to make informed decisions relating to

healthcare. In this lesson, students learn how to use probability to help them make decisions. In

particular, this lesson addressed the serious issue within the United States of unplanned teenage

pregnancy. In this lesson, students investigate the probability of successful use for four different

types of birth control options, the birth control pill, the birth control patch, an intrauterine device,

and a male condom. Students will calculate the conditional probability of joint events, such as a

student taking a birth control pill and getting pregnant, or a student using a male condom and not

getting pregnant. Through calculating these probabilities, students will see that the probability of

a student that is using birth control getting pregnant is very low, especially compared to students

who do not use any birth control method.

One important consideration about this lesson is that the district in which the lesson

writer works is one that has a major problem relating to teenage unplanned pregnancy. In

addition, this district is not an abstinence only school, but instead one that incorporates lessons

regarding safe sexual practices and pregnancy prevention measures into the curriculum. It is very

important to note that while this lesson may not be appropriate for all districts, depending on the

district’s individual policy relating to sexual health practices, the issue of teenage unplanned
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pregnancy does still exist. In addition, unplanned pregnancy is something that can occur at any

age and cause troublesome situations for both the parent and child alike.

This lesson is one with the hope of educating young people on the effectiveness of

various birth control and allowing them to calculate the probability that they will or will not get

pregnant while using certain birth controls, in order to help them make an educated healthcare

decision on this matter in the future. Similarly, the goal of this lesson is to inform students that

many medical decisions, such as surgery success rates, vaccine success rates, and even negative

side effects rates can all be analyzed and understood through the use of probability, allowing

them to then make these critical decisions from an informed perspective.

Lesson three uses a z-test for differences in proportions to help students learn about

making informed decisions between two different healthcare options. In this lesson, students use

data regarding allergen exposure (peanuts) in infants. Infants who had previously shown

evidence of other kinds of allergies were split into two groups. One group ate a baby-food form

of peanut butter as an infant and the other group avoided peanut butter & other peanut products.

At 5 years old, researchers followed up to determine the number of children in each group that

had developed an allergy to peanuts. Students thought about how these decisions could impact

themselves or their future families and developed hypotheses about the researchers' claim.

Students compared the proportion of children who developed a peanut allergy after consuming

peanut products as an infant to those that did not consume peanut products using a z-test for the

difference of proportions. From this experiment, students found that the group with early allergen

exposure was significantly less likely to develop peanut allergies later in childhood than those

that avoided allergens. Students were also asked to consider what type of error was possible in

their experiment and how that error could impact their decision making. Finally, students were
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asked to consider how we can encourage patients to be self-advocates in their healthcare

decision-making processes.

Lesson four, the final lesson, is intended to wrap up the previous three lessons while also

introducing a new idea: what is the cost of all these decisions? Students will reflect on the data

they came up with in lessons 1, 2, and 3. They will consider the informed decisions they made

when looking purely at the statistical results of the studies. Students will be presented with the

average prices of the healthcare they chose. The students will be asked to use this additional

information to make any adjustments to their decisions. They will explain and justify whether

they changed their decision or not in a Pear Deck and the class will be able to review everyone’s

answers. They will do this process for each of the three previous lessons. They will then find the

percentage of the class that changed their decision for each of the three scenarios.

Students will be asked to reflect on why they changed their healthcare decision. What did

they consider? How does their decision reflect their socioeconomic status? How often do they

think people can not get the treatment they need/want due to the cost? Students will then be

asked to discuss with each other ways that people can work to combat the inequality in

healthcare.

Developing a Cohesive Unit

After we had formed our group and put our communication preferences in the Padlet, it

was clear that a text group chat and a shared Google Document was going to be best for all of us

to communicate and form this unit. A chat was created the day after the Padlet information was

posted by each member. Each one of us immediately started discussing logistics of each step of

the project and sharing our ideas. Individually, we took on the responsibility of deciding what we

wanted our own lessons to be and then we asked the group chat for approval, input, and
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suggestions. Every week, we put our work into the group document. Even if the assignment of

the week required us to turn in an individual document, our original work was completed in the

shared document so we could ensure our lesson was remaining cohesive and flowing

appropriately. Our outline came together quickly. It was decided that the first three lessons would

demonstrate different methods of statistical analysis and the final lesson would tie the three

together. We set our sights on informing students how to navigate the world of healthcare when

they become adults and have to make treatment decisions for themselves. Our priority was to

develop a unit that would give them this life skill. Our final lesson called their attention to the

social justice issue of healthcare costs. The students must look at their informed decisions they

made using data from studies and the knowledge about their own selves and reflect upon how the

cost alone can alter their decision making. There are many opportunities throughout all four

lessons for in-depth discussions and a variety of methods in which students can express their

thoughts.

Contributors’ Roles

Each person in the group took on a variety of roles. After a group discussion to focus on

upper high school students and statistics, we each focused on our strengths and interests to

develop our unit plan and our individual lessons. Since Brittany had the biggest connection to

healthcare workers, she took the lead on interviewing a healthcare professional about their

experience with the patient decision-making process. She also interviewed a patient in our target

audience age range for our lessons, a 17 year old female high school senior that is looking ahead

to making their own healthcare decisions after high school graduation. While we all created our

individual lessons separately, the group chat and shared Google document were utilized by

everyone to ensure that our ideas were cohesive but not overlapping each other too much. In the
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development of our lessons, Nikole created a lesson template on Google Slides that we all used

for our final lessons to make sure that our presentations had the same look and feel throughout

the unit. Brianna took on the role of creating a lesson that wrapped up the unit from the previous

three lessons so that students going through the unit could get a sense of conclusion by the end of

the unit and could see how their informed decision-making process is always going to be a work

in progress. For our final paper, Bree took on the role of final editor, ensuring that all references

were in APA style, all points of the outline were fulfilled, and that the paper came together as

one piece. Throughout the paper, everyone contributed to different parts of the final product and

wrote various parts of the paper. Each person wrote about their own lesson and added their final

lesson to the appendix. All together, our unit plan, final paper, & final editing were a

collaborative effort.
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References

American Public Health Association. (2021). Social Justice and health. American Public Health

Association. Retrieved October 16, 2021, from

https://www.apha.org/what-is-public-health/generation-public-health/our-work/social-just

ice.

Frankenstein, M. (2012). Beyond math content and process: Proposals for underlying aspects of

social justice education. In A. A. Wager & D. W. Stinson (Eds.), Teaching mathematics

for social justice: Conversations with educators (pp. 49-62). Reston, VA: N

Gutstein, E. (2007). Connecting community, critical, and classical knowledge in teaching

mathematics for social justice. TMME Monograph 1, 109-118.

Jacobsen, L. J. & Mistele, J. (2011). Mathematics education: What is the point? In B. Atweh, M.

Graven, W. Secada, & P. Valero (Eds.) Mapping Equity and Quality in Mathematics

Education (pp. 555-568). New York: Springer.

National Education Association. (2018, November 2). Talk about racism and racial equity. NEA

EdJustice. Retrieved October 3, 2021, from

https://neaedjustice.org/social-justice-issues/racial-justice/talk-about-racism-and-racial-eq

uity

Nieto, S. (2013). Finding Joy in Teaching Students of Diverse Backgrounds. Portsmouth, NH:

Heinemann. (Chapter 8)

Regis College Online. (2021, April 23). What are examples of social justice in Health Care?

Regis College Online. Retrieved October 16, 2021, from

https://online.regiscollege.edu/blog/social-justice-in-health-care/.
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Theoharis, G. (2007). Social justice educational leaders and resistance: Toward a theory of social

justice leadership. Educational Administration Quarterly, 43(2), 221–258.

https://doi.org/10.1177/0013161x06293717
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Appendix A

Interviews

● Healthcare Workers
○ Nurse Practitioner for 23 years, RN for 11 years prior to becoming an NP.
○ How do you see the future of healthcare? I see fewer individuals becoming
interested in healthcare and I see current healthcare staff leaving their profession
because of the Covid pandemic thereby creating a shortage of healthcare
providers. I think healthcare will continue to be more accessible through the
increased usage of telehealth visits, however. I also see the cost of healthcare
continuing to increase since individuals are living longer. These individuals are
living longer with various chronic health conditions, some of which require
several medications and other modalities to treat their conditions which can be
very costly.
○ How do you stay informed with current advancements in healthcare? I stay
informed of advancements in healthcare through attendance at continuing
education conferences and reading peer-reviewed healthcare journals.
○ What kind of care does a teenager typically need? Typically teenagers are healthy
individuals and are generally only seen for physical exams for sports or entry into
college. It is imperative that at these visits, the provider takes the opportunity to
address health promotion and disease prevention. Teenagers can also be seen for
acute illnesses such as upper respiratory illnesses, urinary tract infections, strep
pharyngitis, allergies, etc. requiring the use of either prescriptive or
over-the-counter medications along.
○ How do you ensure your teenage and young adult patients are being properly
informed about their healthcare? I encourage these age groups to use reputable
websites if they are going to use the internet to seek answers to their healthcare
questions. I strongly encourage them however to ask a trusted healthcare
professional first. When seeing this age group in the office setting, I would make
sure they understood my instructions and would provide them the opportunity to
ask questions to seek further clarification.
○ How do you deal with a teenage or young adult patient that does not disclose or
communicate important information with you? How do you manage the situation
to ensure the best care? I remind them that in order to treat them properly, they
need to disclose/communicate important information to me even if it is
uncomfortable or embarrassing. I also remind them that the information shared
with me will remain confidential.
○ Imagine you had to communicate bad news to a teenage/young adult patient, how
would you manage the situation in order to ensure your patient is informed on the
news and all possible course of action in order to make the most informed
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decision for themselves? I would have the patient schedule an in-person visit and
allow extra time for that appointment to ensure that ample time is allotted to
provide all the necessary information and to allow for answering of questions. I
would research the most up-to-date treatment options that are available and would
present these options to the patient. I would provide written material from
reputable sources (if available) for the patient to take home to review to assist in
helping the patient make an informed decision.
● Patients
○ 17 year old, female, senior in high school
○ Do you know who your insurance provider is? Yes
○ Do you know how to determine which providers are in-network for your
insurance? No
○ Can you ask your healthcare provider questions over the phone or do you have to
make an appointment? You can ask some over the phone but others you need an
appointment for
○ Do you feel comfortable providing all healthcare-related information to your
provider? Yes
○ Do you think you are prepared to ask your provider follow-up questions regarding
a diagnosis to better understand the condition and possible treatment options? Yes
○ How can you ensure as the patient that you are being fully informed regarding
your healthcare? Do your own research
○ What are important pieces of your health history that a new doctor would need to
know prior to treating you? Prior health issues and family medical history
○ What is preventive care and how can it help you stay healthy? Preventative care is
when you diagnose issues before they become serious. This can help you stay
healthy because you can treat issues before they become more serious.
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Appendix B

Lessons

Lesson 1

Link to Lesson: Lesson 1 - Informed Decisions - Using Mean, Standard-Deviation, and Variance

Lesson 2

Link to Lesson: Lesson 2 - Using Conditional Probability

Lesson 3

Link to Lesson: Lesson 3 - Making Decisions About Treatment Options

Lesson 4

Link to Lesson: Lesson 4 - The Cost of Healthcare - A Social Justice Discussion