Attitudes and Approaches to Decision Making About Antihypertensive Treatment in Elderly Patients

Perret‐Guillaume, Christine; Genet, Chantal; Herrmann, Françoís; Bénétos, Athanase; Hurst, Samia; Vischer, Ulrich M.

doi:10.1016/j.jamda.2010.07.004

Cited by 10 publications

(12 citation statements)

References 35 publications

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“…And, as other studies have shown, even patients with low DCPs prefer to obtain information about their illness and options from their clinicians before a decision is made. 18,19,35 These results suggest that all patients, especially those who feel less ready, can be encouraged to engage in their health care and ask questions.…”

Section: Discussionmentioning

confidence: 97%

“Doctor, Make My Decisions”: Decision Control Preferences, Advance Care Planning, and Satisfaction With Communication Among Diverse Older Adults

Chiu

Feuz

McMahan

et al. 2016

Journal of Pain and Symptom Management

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Context Culturally diverse older adults may prefer varying control over medical decisions. Decision control preferences (DCPs) may profoundly affect advance care planning (ACP) and communication. Objectives To determine the DCPs of diverse, older adults and whether DCPs are associated with participant characteristics, ACP, and communication satisfaction. Methods A total of 146 participants were recruited from clinics and senior centers in San Francisco. We assessed DCPs using the Control Preferences Scale: doctor makes all decisions (low), shares with doctor (medium), makes own decisions (high). We assessed associations between DCPs and demographics; prior advance directives; ability to make in-the-moment goals of care decisions; self-efficacy, readiness, and prior asked questions; and satisfaction with patient-doctor communication (on a 5-point Likert scale), using Chi-square and Kruskal-Wallis analysis of variance. Results Mean age was 71±10 years, 53% were non-white, 47% completed an advance directive, and 70% made goals of care decisions. Of the sample, 18% had low DCPs, 33% medium, and 49% high. Older age was the only characteristic associated with DCPs (low: 75 years ±11, medium: 69±10, high: 70±9, P=0.003). DCPs were not associated with ACP, in-the-moment decisions, or communication satisfaction. Readiness was the only question-asking behavior associated (low: 3.8±1.2, medium: 4.1±1.2, high: 4.3±1.2, P=0.05). Conclusion Nearly one-fifth of diverse, older adults want doctors to make their medical decisions. Older age and lower readiness to ask questions were the only demographic variables significantly associated with low DCPs. Yet, older adults with low DCPs still engaged in ACP, asked questions, and reported communication satisfaction. Clinicians can encourage ACP and questions for all patients, but should assess DCPs to provide the desired amount of decision support.

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Section: Discussionmentioning

confidence: 97%

“Doctor, Make My Decisions”: Decision Control Preferences, Advance Care Planning, and Satisfaction With Communication Among Diverse Older Adults

Chiu

Feuz

McMahan

et al. 2016

Journal of Pain and Symptom Management

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show abstract

“…Thirty-nine studies met our age-related eligibility criteria by exclusively including adults aged 65 years and older, 32,35,[37][38][39]41,42,[44][45][46][49][50][51][52][53][54][55][56][57][58][59][60][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78] 16 by reporting a mean or median age ≥ 75 years, 31,36,40,43,47,48,61,[79][80][81][82]…”

Section: Study Populationsmentioning

confidence: 99%

“…42,47,49,51,52,54,56,57,71,74,79 Thirty-seven studies reported data regarding the cognitive status of their participants. 31,32,35,36,[41][42][43][44]47,49,[51][52][53][55][56][57][58][59][60][61][63][64][65][66][67][68][69][70][71][72]74,75,78,80,83,84,90 In 83.8 % of these studies Variety of pharmacological aspects represented by the method ▼ Low: Method elicits preferences for < 5 different pharmacological aspects (health outcomes, treatment options or procedural characteristics) ▬ Intermediate: Method elicits preferences for 5-10 different pharmacological aspects (health outcomes, treatment options or procedural characteristics) ▲ Hi...…”

Section: Study Populationsmentioning

confidence: 99%

“…Seventeen studies detailed the results of a standardized cognitive evaluation of their study population. 32,36,43,51,52,55,66,[68][69][70][71][72]74,78,80,83,84 The participants' affective status was considered by 30 studies ( Table 2).…”

Section: Study Populationsmentioning

confidence: 99%

“…The majority of the identified 55 instruments were designed to assess patient preferences within a diseasespecific or context-specific setting. The most prevalent contexts were various types of cancer (9 tools), 33,41,48,55,66,72,86,90 mental health issues including depression (7 tools), 43,45,67,71,73,75,82,83 cardiovascular prevention (7 tools), 46,47,60,61,63,74,88 stroke prevention in atrial fibrillation (5 tools), 32,42,44,50,80 and age-related macular degeneration (4 tools). 79,81,85,87 Only three tools were designed for the greater context of multimorbidity: the Outcome Prioritization Tool, 56,57,59,60,65 the complex intervention "PrefCheck" combining a comprehensive geriatric assessment ("STEP assessment") with a health priority evaluation, [68][69][70]78 and the "MediMol" questionnaire.…”

Section: Study Contextmentioning

confidence: 99%

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<p>Methods to Assess Patient Preferences in Old Age Pharmacotherapy – A Systematic Review</p>

Eidam¹,

Roth²,

Lacroix³

et al. 2020

PPA

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Purpose: The aim of this systematic review was to identify methods used to assess medication preferences in older adults and evaluate their advantages and disadvantages with respect to their applicability to the context of multimorbidity and polypharmacy. Material and Methods: Three electronic databases (PubMed, Web of Science, PsycINFO) were searched. Eligible studies elicited individual treatment or outcome preferences in a context that involved long-term pharmacological treatment options. We included studies with a study population aged ≥ 65 years and/or with a mean or median age of ≥ 75 years. Qualitative studies, studies assessing preferences for only two different treatments, and studies targeting preferences for life-sustaining treatments were excluded. The identified preference measurement methods were evaluated based on four criteria (time budget, cognitive demand, variety of pharmacological aspects, and link with treatment strategies) judged to be relevant for the elicitation of patient preferences in polypharmacy. Results: Sixty articles met the eligibility criteria and were included in the narrative synthesis. Fifty-five different instruments to assess patient preferences, based on 24 different elicitation methods, were identified. The most commonly applied preference measurement techniques were "medication willingness" (description of a specific medication with inquiry of the participant's willingness to take it), discrete choice experiments, Likert scale-based questionnaires, and rank prioritization. The majority of the instruments were created for disease-specific or context-specific settings. Only three instruments (Outcome Prioritization Tool, a complex intervention, "MediMol" questionnaire) dealt with the broader issue of geriatric multimorbidity. Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy. Conclusion: Up to now, few instruments have been specifically designed for the assessment of medication preferences in older patients with multimorbidity. To facilitate valid preference elicitation in the context of geriatric polypharmacy, future research should focus on suitable characteristics of existing techniques to develop new measurement approaches for this increasingly relevant population.

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Hypertension in the Very Old: Special Features, Therapeutic Approaches, and Problems

Bénétos

Vischer

Watfa

2012

Special Issues in Hypertension

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Attitudes and Approaches to Decision Making About Antihypertensive Treatment in Elderly Patients

Cited by 10 publications

References 35 publications

“Doctor, Make My Decisions”: Decision Control Preferences, Advance Care Planning, and Satisfaction With Communication Among Diverse Older Adults

“Doctor, Make My Decisions”: Decision Control Preferences, Advance Care Planning, and Satisfaction With Communication Among Diverse Older Adults

<p>Methods to Assess Patient Preferences in Old Age Pharmacotherapy – A Systematic Review</p>

Hypertension in the Very Old: Special Features, Therapeutic Approaches, and Problems

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