Understanding What Is Most Important to Individuals with Multiple Chronic Conditions: A Qualitative Study of Patients’ Perspectives

Lim, Catherine; Berry, Andrew; Hirsch, Tad; Hartzler, Andrea L.; Wagner, Edward H.; Ludman, Evette; Ralston, James D.

doi:10.1007/s11606-017-4154-3

Cited by 57 publications

(83 citation statements)

References 53 publications

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“…Prior research has suggested that these concerns may receive less attention than medically defined problems during primary care visits. 25,26 In prior studies, identification of psychosocial concerns was by physicians rather than by patients. We had the unique opportunity to examine primary care interactions based on patient-defined visit priorities.…”

Section: Resultsmentioning

confidence: 99%

Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns

Santo

Uratsu

et al. 2019

J Am Board Fam Med

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Background: Primary care providers (PCPs) are often challenged to address multiple patient concerns during time-limited visits. The need for PCPs to limit the number of issues addressed may have a negative impact on discussion of patient-defined visit priorities. Methods: Using data from a recent clinical trial (Aligning Patients and Providers, ClinicalTrials.gov: NCT02707146), we examined the association between patient-defined visit priorities and subsequent provider actions taken during and after the visit. We tested the hypothesis that psychosocial concerns (eg, stress, anxiety, caregiving demands) are less likely to be addressed than traditional medical concerns. Results: We analyzed 147 patient-defined visit priorities submitted just before the visit by 109 patients (mean age, 59.0 ؎ 12.7 years; including 73.4% women, 47.7% non-White race/ethnicity). Nearly one quarter of patient-defined visit priorities were related to psychosocial concerns (35/147; 23.8%). In models adjusting for age, gender, race/ethnicity, and familiarity with PCP, patients' psychosocial priorities were significantly less likely than medical priorities to be addressed during the visit (63% vs. 88%; adjusted odds ratio [aOR], 0.16; 95% CI, 0.06 to 0.41; P < .001), to receive clinical action (51% vs. 82%; aOR, 0.15; 95% CI, 0.06 to 0.38; P < .001), or to receive post visit information from the primary care doctor (17% vs. 32%; aOR, 0.39; 95% CI, 0.14 to 1.08; P ‫؍‬ .07). Conclusions: Patient-defined psychosocial priorities are less likely to be addressed during (or immediately after) primary care visits compared with patient-defined medical priorities.

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Section: Resultsmentioning

confidence: 99%

Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns

Santo

Uratsu

et al. 2019

J Am Board Fam Med

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“…Prior work on methods for eliciting and clarifying values in clinical settings typically focus on eliciting patients' preferences in making individual medical decisions from a set of closed-ended diagnostic or treatment options [44]. Recent work has sought to expand the breadth of values that may be valuable for informing individualized, patient-centered care [27,32]. Domains of values important to people with MCC include those not typically discussed in clinical contexts: activities, possessions, principles, relationships, emotions, and abilities [10,27].…”

Section: Related Work Communication About Patients' Valuesmentioning

confidence: 99%

“…Recent work has sought to expand the breadth of values that may be valuable for informing individualized, patient-centered care [27,32]. Domains of values important to people with MCC include those not typically discussed in clinical contexts: activities, possessions, principles, relationships, emotions, and abilities [10,27].…”

Section: Related Work Communication About Patients' Valuesmentioning

confidence: 99%

“…Efforts to improve healthcare for the growing population of people with MCC [21,43] emphasize the need to orient care around outcomes important to patients [2,41]. Recent work has sought to address the need to support patients, family caregivers, and healthcare providers to align care with patients' values [33]-what patients consider most important to their well-being and health [10,27]. Yet, eliciting patients' values is not a routine part of care [9].…”

Section: Introductionmentioning

confidence: 99%

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Facilitating Self-reflection about Values and Self-care Among Individuals with Chronic Conditions

Lim

Berry

Hartzler

et al. 2019

Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems

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Individuals with multiple chronic conditions (MCC) experience the overwhelming burden of treating MCC and frequently disagree with their providers on priorities for care. Aligning self-care with patients' values may improve healthcare for these patients. However, patients' values are not routinely discussed in clinical conversations and patients may not actively share this information with providers. In a qualitative field study, we interviewed 15 patients in their homes to investigate techniques that encourage patients to articulate values, self-care, and how they relate. Study activities facilitated self-reflection on values and self-care and produced varying responses, including: raising consciousness, evolving perspectives, identifying misalignments, and considering changes. We discuss how our findings extend prior work on supporting reflection in HCI and inform the design of tools for improving care for people with MCC. CCS CONCEPTS • Human-centered computing → Empirical studies in HCI; Interaction design.

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“…The authors sought to identify what patients with MCC view as most important to their well-being and health. 8 The researchers interviewed 31 older adults (mean age 68.7 years) with diabetes mellitus and at least two other common chronic conditions (depression, osteoarthritis, and coronary artery disease) who received care in a single integrated health care system in Washington state. The authors interviewed patients in their own homes, with optional inclusion of family Published online September 18, 2017 members (18 spouses and 1 adult child participated).…”

mentioning

confidence: 99%

Eliciting Personal Values of Patients with Multiple Chronic Conditions: Why and How

Heisler

2017

J GEN INTERN MED

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Understanding What Is Most Important to Individuals with Multiple Chronic Conditions: A Qualitative Study of Patients’ Perspectives

Abstract: The domains describe the range and types of personal values multimorbid older adults deem important to well-being and health. Understanding patients' personal values across these domains may be useful for providers when developing, sharing, and following up on care plans.

Cited by 57 publications

References 53 publications

Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns

Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns

Facilitating Self-reflection about Values and Self-care Among Individuals with Chronic Conditions

Eliciting Personal Values of Patients with Multiple Chronic Conditions: Why and How

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