How older patients prioritise their multiple health problems: a qualitative study

Abstract

BackgroundPatients with multimorbidity often receive diverse treatments; they are subjected to polypharmacy and to a high treatment burden. Hence it is advocated that doctors set individual health and treatment priorities with their patients. In order to apply such a concept, doctors will need a good understanding of what causes patients to prioritise some of their problems over others. This qualitative study explores what underlying reasons patients have when they appraise their health problems as more or less important.MethodsWe undertook semi-structured interviews with a purposive sample of 34 patients (aged 70 years and over) in German general practices. Initially, patients received a comprehensive geriatric assessment, on the basis of which they rated the importance of their uncovered health problems. Subsequently, they were interviewed as to why they considered some of their problems important and others not. Transcripts were analysed using qualitative content analysis.ResultsPatients considered their health problems important, if they were severe, constant, uncontrolled, risky or if they restricted daily activities, autonomy and social inclusion. Important problems often correlated with negative feelings. Patients considered problems unimportant, if they were related to a bearable degree of suffering, less restrictions in activities, or psychological adjustment to diseases. Altogether different reasons occurred on the subject of preventive health issues.ConclusionsPatients assess health problems as important if they interfere with what they want from life (life values and goals). Psychological adjustment, by contrast, facilitates a downgrading of the importance. Asking patients with multimorbidity, which health problems are important, may guide physicians to treatment priorities and health problems in need of empowerment.

Multimorbidity and its effect on perceived burden, capacity and the ability to self-manage in a low-income rural primary care population: A qualitative study

“…Several studies [ 15 , 16 , 18 , 22 ], have reported that patients prioritise health conditions based on their functional impact, and this study reports similar findings. Analysis of specific capacity domains showed that pain and mental health conditions (as well as diabetic foot ulcers) had the greatest impact on capacity.…”

“…In clinical practice, this has led to each condition being managed as a separate entity [ 10 ], with precedence given to conditions with a higher risk of future adverse outcomes such as diabetes or cardiovascular disease [ 13 , 14 ]. Interviews with patients suggest that they approach multimorbidity differently, placing greater importance on symptomatic conditions affecting their quality of life [ 15 – 19 ]. This preference has implications for health outcomes, with conditions that may have low symptom burden but high future risk being deprioritised or ignored by patients [ 16 ].…”

Expectativa de vida com e sem multimorbidade entre idosos brasileiros: Pesquisa Nacional de Saúde 2013

“…Em geral, o que ocorre no cotidiano dos serviços é que pacientes com multimorbidade, geralmente, recebem tratamentos diversos; estão sujeitos à polifarmácia e a uma alta carga de tratamento. Muitas vezes, ainda, a decisão pelas prioridades individuais de saúde e tratamento conta muito pouco com a percepção do próprio idoso, estando, com frequência, ligada à gravidade das doenças e, principalmente, às restrições provocadas nas atividades diárias, autonomia e inclusão social (JUNIUS-WALKER et al, 2019). Supõe-se, portanto, que perguntar aos pacientes com multimorbidade que problemas de saúde são importantes pode orientar a equipe de saúde para as prioridades de tratamento e problemas de saúde que necessitam de empoderamento.…”

Preferences and priorities to manage clinical uncertainty for older people with frailty and multimorbidity: a discrete choice experiment and stakeholder consultations

“…Having a shared understanding of the uncertainty of the patient’s condition could enable the family to adjust expectations of level of recovery and support the patient’s adaptation to change in function as well as continuity of care. For older people, psychological adjustment to conditions may be a lower priority than problems that hinder their independence [ 38 ]. Understanding the patient’s priorities for care is key to understand how older patients prioritise their multiple health conditions.…”