Abstract
Older adults’ experiences with their healthcare are burdensome and often do not address what matters most. This dilemma arises because clinical decision-making is guided by single-disease guidelines rather than the health priorities of older adults. Most older adults have multiple chronic conditions that require a more collaborative approach to decision-making. The Model of Collaborative Decision-Making consists of two intersecting pathways. The first engages older adults to frame what matters to them into specific, realistic, and actionable health outcome goals based on the constraints of their personal lives and health trajectory. In the second pathway, older adults offer their preferences regarding which care is helpful and bothersome to inform clinician recommendations for care that aligns with patients’ health outcome goals. In this paradigm of priorities-aligned care, the value of healthcare derives from how well it achieves patients’ outcome goals, and its appropriateness is based on if patients are willing and able to use it. Patient Priorities Care is an evidence-based approach to collaborative decision-making for older, multimorbid adults and their clinicians. Patient Priorities Care results in care that is less burdensome and more aligned with the health outcome goals and care preferences identified by older adults. Patient Priorities Care holds promise as a favored healthcare approach for older adults with multiple morbidities.
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References
Berwick DM. A user’s manual for the IOM’s ‘Quality Chasm’ report. Health Aff. 2002;21(3):80–90.
Vespa J, Armstrong DM, Medina L. Demographic turning points for the United States: population projections for 2020 to 2060. Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau; 2020.
Hajat C, Stein E. The global burden of multiple chronic conditions: a narrative review. Prev Med Rep. 2018;12:284–93.
Parsons T. The sick role and the role of the physician reconsidered. Milbank Mem Fund Q Health Soc. 1975;53:257–78.
Sackett DL, Rosenberg WM, Gray JM, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn’t. BMJ. 1996;312:71–2.
Ioannidis JP. Evidence-based medicine has been hijacked: a report to David Sackett. J Clin Epidemiol. 2016;73:82–6.
Naik AD. Measuring patient-centered care to improve hospital experiences of older adults. Wiley Online Library; 2022. p. 3348–51.
Naik A, Arney J, Clark J, et al. Integrated model for patient-centered advanced liver disease care. Clin Gastroenterol Hepatol. 2020;18(5):1015–24.
Arney J, Gray C, Walling AM, et al. Two mental models of integrated care for advanced liver disease: qualitative study of multidisciplinary health professionals. BMJ Open. 2022;12(9):e062836.
Rockwood K. What do we treat patients for? Am J Med. 2001;110(2):151–2.
Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept: (see editorial comments by Dr. William Hazzard on pp 794–796). J Am Geriatr Soc. 2007;55(5):780–91.
Tinetti ME, Fried T. The end of the disease era. Am J Med. 2004;116(3):179–85.
Zulman DM, Sussman JB, Chen X, Cigolle CT, Blaum CS, Hayward RA. Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med. 2011;26:783–90.
O’Hare AM, Hotchkiss JR, Tamura MK, et al. Interpreting treatment effects from clinical trials in the context of real-world risk information: end-stage renal disease prevention in older adults. JAMA Intern Med. 2014;174(3):391–7.
Oscanoa T, Lizaraso F, Carvajal A. Hospital admissions due to adverse drug reactions in the elderly. A meta-analysis. Eur J Clin Pharmacol. 2017;73:759–70.
Fried TR, Tinetti ME, Iannone L, O’Leary JR, Towle V, Van Ness PH. Health outcome prioritization as a tool for decision making among older persons with multiple chronic conditions. Arch Intern Med. 2011;171(20):1856–8.
Jowsey T, Yen L, Mathews P. Time spent on health-related activities associated with chronic illness: a scoping literature review. BMC Public Health. 2012;12(1):1044.
Frampton S. Healthcare and the patient experience: harmonizing care and environment. Health Environ Res Des J. 2012;5(2):3.
Manary MP, Boulding W, Staelin R, Glickman SW. The patient experience and health outcomes. N Engl J Med. 2013;368:201–3.
Naik AD. On the road to patient centeredness. JAMA Intern Med. 2013;173(3):218–9. https://doi.org/10.1001/jamainternmed.2013.1229.
Naik AD, Walling AM. Getting patients ready for “in the moment” decisions. Wiley Online Library; 2022. p. 2474–7.
Naik AD, Dindo LN, Van Liew JR, et al. Development of a clinically feasible process for identifying individual health priorities. J Am Geriatr Soc. 2018;66(10):1872–9.
Damasio A. The neurobiological grounding of human values. In: Neurobiology of human values. Springer; 2005. p. 47–56.
Graham, J., Haidt, J., Koleva, S., Motyl, M., Iyer, R., Wojcik, S.P. and Ditto, P.H., 2013. Moral foundations theory: The pragmatic validity of moral pluralism. Advances Experimental Social Psychology 2013;47:55–130.
Reyna VF. How people make decisions that involve risk: a dual-processes approach. Curr Dir Psychol Sci. 2004;13(2):60–6.
Naik AD, McCullough LB. Health intuitions inform patient-centered care. Am J Bioeth. 2014;14(6):1–3.
Naik AD, Martin LA, Moye J, Karel MJ. Health values and treatment goals of older, multimorbid adults facing life-threatening illness. J Am Geriatr Soc. 2016;64(3):625–31.
Karel MJ, Mulligan EA, Walder A, Martin LA, Moye J, Naik AD. Valued life abilities among veteran cancer survivors. Health Expect. 2016;19(3):679–90.
Locke EA, Latham GP. The development of goal setting theory: a half century retrospective. Motiv Sci. 2019;5(2):93.
Wade DT. Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil. 2009;23(4):291–5.
Mate K, Fulmer T, Pelton L, et al. Evidence for the 4Ms: interactions and outcomes across the care continuum. J Aging Health. 2021. https://doi.org/10.1177/0898264321991658.
Emery-Tiburcio EE, Mack L, Zonsius MC, Carbonell E, Newman M. The 4Ms of an age-friendly health system. AJN Am J Nurs. 2021;121(11):44–9.
Feder SL, Kiwak E, Costello D, et al. Perspectives of patients in identifying their values-based health priorities. J Am Geriatr Soc. 2019.
Tinetti ME, Naik AD, Dindo L, et al. Association of patient priorities–aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Intern Med. 2019. https://doi.org/10.1001/jamainternmed.2019.4235.
Tinetti ME, Costello DM, Naik AD, et al. Outcome goals and health care preferences of older adults with multiple chronic conditions. JAMA Netw Open. 2021;4(3):e211271.
Freytag J, Dindo L, Catic A, et al. Feasibility of clinicians aligning health care with patient priorities in geriatrics ambulatory care. J Am Geriatr Soc. 2020;68(9):2112–6. https://doi.org/10.1111/jgs.16662.
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Naik, A.D. (2023). Collaborative Decision-Making. In: Wasserman, M.R., Bakerjian, D., Linnebur, S., Brangman, S., Cesari, M., Rosen, S. (eds) Geriatric Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-01782-8_2-1
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DOI: https://doi.org/10.1007/978-3-030-01782-8_2-1
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