Patient-Centeredness in Older Adults With Multimorbidity: Results of an Online Expert Delphi Study

Abstract

Background and Objectives Older adults suffering from multimorbidity represent a priority target group for patient-centeredness (PC). We aimed to investigate the transferability of an existing integrated model of PC comprising 15 dimensions on the care of older adults with multimorbidity from an expert perspective. Research Design and Methods 242 experts were invited to participate in a two-round online Delphi study. In the first round they were asked to 1) individually rate relevance and clarity of the dimensions, 2) add missing dimensions, and 3) prioritize the dimensions. In round two, experts received results of round one and were asked to re-rate their ratings. Results 48 experts participated in round one, 39 in round two. Ten dimensions were rated as sufficiently relevant and clear, including one new dimension (‘prognosis and life expectancy, burden of treatment’). Four dimensions were rated as relevant but insufficiently clear. One dimension failed to reach our validation threshold on both criteria. The five dimensions rated as most important were: ‘patient as a unique person’, ‘clinician-patient communication’, ‘patient involvement in care’, ‘physical, cognitive and emotional support’, ‘involvement of family and friends’. Discussion and Implications The experts’ ratings were higher regarding relevance than regarding clarity, which emphasizes the still existing conceptual uncertainty of PC. Our results give further directions regarding the operationalization of PC in older adults with multimorbidity, which is essential for its implementation in routine care. Further refined using focus groups with geriatric patients, our adapted model serves as a basis for a systematic review of assessment instruments.

Patient-centeredness in the multimorbid elderly: a focus group study

“…Considering the rather deductive approach of our study and the fact that the emerging topics could be fully assigned to our pre-defined PC dimensions, data saturation may be assumed. Of note, our study findings suggest that the perceptions of multimorbid older people correspond closely with PC’s conceptual dimensions as experts have proposed [ 41 ], and with current guidelines for the patient-centered care of elderly people with multimorbidtiy [ 19 ]. Together, these different perspectives may be integrated within a population-specific adaptation of the PC model which will serve to develop patient-centered interventions and assessment instruments for PC in this specific patient group.…”

“…Population-specific aspects not covered by the existing model’s dimensions were assigned to the newly-proposed PC dimension ‘individual care needs related to aging and chronic disease’. This dimension was developed on the basis of an initial literature search and expert Delphi survey within our research project [ 41 ] and has now been confirmed from the patient’s perspective within the current study.…”

“…Previous Delphi surveys have validated the integrative model of PC from the perspective of experts [ 41 , 55 ]. A recent study focussed on patients’ perceptions [ 36 ].…”

“…This search revealed ‘prognosis, life expectancy, and treatment burden’ as additional aspects of PC for our target group. These were validated within a Delphi-survey with experts in geriatric health care (in round 1 with n = 48 experts, in round 2 with n = 39 experts) [ 41 ] and included as a preliminary category within our coding system. Coding rules were defined to resolve conflicts in case of reduced identifiabilty of categories.…”

The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care?

“…The decision-making about tailoring critical care for multi-morbid individuals, especially in the very old, require consideration and weighting of patient-centred outcome measures such as quality of life vs burden of treatment [33]. Short-and long-term goals should be determined by the expectations of the individual patient, which may differ from recommendations for managing single conditions in younger people.…”