Relationship Between Universal Health Outcome Priorities and Willingness to Take Medication for Primary Prevention of Myocardial Infarction

Case, Siobhan; OʼLeary, John R.; Kim, Nancy; Tinetti, Mary E.; Fried, Terri R.

doi:10.1111/jgs.12983

Cited by 12 publications

(26 citation statements)

References 38 publications

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“…However, what it means to achieve these “universal” outcomes is often very individualized. 34, 35 Moreover, there are trade-offs even among these commonly desired health outcomes (e.g., accepting less functional independence because of pain and effort associated with intensive physical therapy following a hip fracture). 4, 36 Other goals that are important to patients and caregivers are more idiosyncratic and patient-specific (e.g., being able to attend a grandchild’s wedding) and are usually not captured in clinical practice because they fall outside of traditional medical care.…”

Section: Discussionmentioning

confidence: 99%

Patient and caregiver goals for dementia care

et al. 2016

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Purpose Most health outcome measures for chronic diseases do not incorporate specific health goals of patients and caregivers. To elicit patient-centered goals for dementia care, we conducted a qualitative study using focus groups of people with early-stage dementia and dementia caregivers. Methods We conducted 5 focus groups with 43 participants (7 with early-stage dementia and 36 caregivers); 15 participants were Spanish-speaking. Verbatim transcriptions were independently analyzed line-by-line by two coders using both deductive and inductive approaches. Coded texts were grouped into domains and developed into a goal inventory for dementia care. Results Participants identified 41 goals for dementia care within five domains (medical care, physical quality of life, social and emotional quality of life, access to services and supports, and caregiver support). Caregiver goals included ensuring the safety of the person with dementia and managing caregiving stress. Participants with early-stage dementia identified engaging in meaningful activity (e.g., work, family functions) and not being a burden on family near the end of life as important goals. Participants articulated the need to readdress goals as the disease progressed and reported challenges in goal-setting when goals differed between the person with dementia and the caregiver (e.g., patient safety vs. living independently at home). While goals were similar among English and Spanish-speaking participants, Spanish-speaking participants emphasized the need to improve community education about dementia. Conclusions Patient- and caregiver-identified goals for care are different than commonly measured health outcomes for dementia. Future work should incorporate patient-centered goals into clinical settings and assess their usefulness for dementia care.

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Section: Discussionmentioning

confidence: 99%

Patient and caregiver goals for dementia care

et al. 2016

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“…Health care for these older adults is complex, with inherent tradeoffs between desired outcomes or healthcare options and between outcome goals and healthcare preferences . When faced with tradeoffs, people vary in their health and healthcare priorities . Priorities include health outcome goals—what they want from their health care and their healthcare preferences—what healthcare activities they are willing and able to perform, and the care they are willing or not willing to receive .…”

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confidence: 99%

“…1 When faced with tradeoffs, people vary in their health and healthcare priorities. [2][3][4][5] Priorities include health outcome goals-what they want from their health care and their healthcare preferences-what healthcare activities they are willing and able to perform, and the care they are willing or not willing to receive. 6 Identifying priorities provides a means of reducing the tradeoffs between outcome goals, between healthcare preferences, and between outcome goals and healthcare preferences.…”

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confidence: 99%

Development of a Clinically Feasible Process for Identifying Individual Health Priorities

Naik

Dindo

Liew

et al. 2018

J American Geriatrics Society

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155

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Objectives To develop a values‐based, clinically feasible process to help older adults identify health priorities that can guide clinical decision‐making. Design Prospective development and feasibility study. Setting Primary care practice in Connecticut. Participants Older adults with 3 or more conditions or taking 10 or more medications (N=64). Intervention The development team of patients, caregivers, and clinicians used a user‐centered design framework—ideate → prototype → test →redesign—to develop and refine the value‐based patient priorities care process and medical record template with trained clinician facilitators. Measurements We used descriptive statistics of quantitative measures (percentage accepted invitation and completed template, duration of process) and qualitative analysis of barriers and enablers (challenges and solutions identified, facilitator perceptions). Results We developed and refined a process for identifying patient health priorities that was typically completed in 35 to 45 minutes over 2 sessions; 64 patients completed the process. Qualitative analyses were used to elucidate the characteristics and training needed for the patient priorities facilitators, as well as perceived benefits and challenges of the process. Refinements based on our experience and feedback include streamlining the process for greater feasibility, balancing fidelity to the process while customizing to individuals, encouraging patients to share their priorities with their clinicians, and simplifying the template transmitted to clinicians. Conclusion Trained facilitators conducted this process in a busy primary care practice, suggesting that patient priorities identification is feasible and acceptable, although testing in additional settings is necessary. We hope to show that clinicians can align care with patients' health priorities.

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“…These patients also vary in their health priorities. Health priorities are the health outcome goals that patients most desire from their healthcare within the context of their healthcare preferences, that is, the healthcare activities that patients are willing and able to do to achieve these outcomes . Healthcare decision making informed by patient health priorities allows clinicians to align their plan of care to what matters most to the patient, avoiding conflicting recommendations, better selecting among various care options, and reducing treatment burden …”

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confidence: 99%

“…Health priorities are the health outcome goals that patients most desire from their healthcare within the context of their healthcare preferences, that is, the healthcare activities that patients are willing and able to do to achieve these outcomes. [6][7][8][9][10][11][12] Healthcare decision making informed by patient health priorities allows clinicians to align their plan of care to what matters most to the patient, avoiding conflicting recommendations, better selecting among various care options, and reducing treatment burden. 11 In 2014, a national group of stakeholders representing varied healthcare perspectives (clinicians, both primary and specialty, health system leaders, health insurance providers, patients, caregivers, experts in health IT and design) initiated an 18-month process to design a healthcare prototype to help patients with multiple chronic conditions identify and communicate their health priorities.…”

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confidence: 99%

Perspectives of Patients in Identifying Their Values‐Based Health Priorities

Feder

Kiwak

Costello

et al. 2019

J American Geriatrics Society

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OBJECTIVES Patient Health Priorities Identification (PHPI) is a values‐based process in which trained facilitators assist older adults with multiple chronic conditions identify their health priorities. The purpose of this study was to evaluate patients’ perceptions of PHPI. DESIGN Qualitative study using thematic analysis. SETTING In‐depth semistructured telephone and in‐person interviews. PARTICIPANTS Twenty‐two older adults who participated in the PHPI process. MEASUREMENTS Open‐ended questions about patient perceptions of the PHPI process, perceived benefits of the process, enablers and barriers to PHPI, and recommendations for process enhancement. RESULTS Patient interviews ranged from 9 to 63 minutes (median = 20 min; interquartile range = 15–26). The mean age was 80 years (standard deviation = 7.96), 64% were female, and all patients identified themselves as white. Of the sample, 73% reported no caregiver involvement in their healthcare; 36% lived alone. Most patients felt able to complete the PHPI process with ease. Perceived benefits included increased knowledge and insight into disease processes and treatment options, patient activation, and enhanced communication with family and clinicians. Patients identified several factors that were both enablers and barriers to PHPI including facilitator characteristics, patient demographic and clinical characteristics, social support, relationships between the patient and their primary care provider, and the changing health priorities of the patient. Recommendations for process enhancement included more frequent and flexible facilitator contacts, selection of patients for participation based on specific patient characteristics, clarification of process aims and expectations, involvement of family, written reminders of established health priorities, short duration between facilitation and primary care provider follow‐up, and the inclusion of health‐related tasks in facilitation visits. CONCLUSIONS Patients found the PHPI process valuable in identifying actionable health priorities and healthcare goals leading to enhanced knowledge, activation, and communication regarding their treatment options and preferences. PHPI may be useful for aligning the healthcare that patients receive with their values‐based priorities.

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Relationship Between Universal Health Outcome Priorities and Willingness to Take Medication for Primary Prevention of Myocardial Infarction

Cited by 12 publications

References 38 publications

Patient and caregiver goals for dementia care

Patient and caregiver goals for dementia care

Development of a Clinically Feasible Process for Identifying Individual Health Priorities

Perspectives of Patients in Identifying Their Values‐Based Health Priorities

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