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Collaborative Decision-Making

Identifying and Aligning Care with the Health Priorities of Older Adults

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Geriatric Medicine
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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

  1. Berwick DM. A user’s manual for the IOM’s ‘Quality Chasm’ report. Health Aff. 2002;21(3):80–90.

    Article  Google Scholar 

  2. 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.

    Google Scholar 

  3. Hajat C, Stein E. The global burden of multiple chronic conditions: a narrative review. Prev Med Rep. 2018;12:284–93.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Parsons T. The sick role and the role of the physician reconsidered. Milbank Mem Fund Q Health Soc. 1975;53:257–78.

    Article  CAS  PubMed  Google Scholar 

  5. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Ioannidis JP. Evidence-based medicine has been hijacked: a report to David Sackett. J Clin Epidemiol. 2016;73:82–6.

    Article  PubMed  Google Scholar 

  7. Naik AD. Measuring patient-centered care to improve hospital experiences of older adults. Wiley Online Library; 2022. p. 3348–51.

    Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rockwood K. What do we treat patients for? Am J Med. 2001;110(2):151–2.

    Article  CAS  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tinetti ME, Fried T. The end of the disease era. Am J Med. 2004;116(3):179–85.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Frampton S. Healthcare and the patient experience: harmonizing care and environment. Health Environ Res Des J. 2012;5(2):3.

    Google Scholar 

  19. Manary MP, Boulding W, Staelin R, Glickman SW. The patient experience and health outcomes. N Engl J Med. 2013;368:201–3.

    Article  CAS  PubMed  Google Scholar 

  20. Naik AD. On the road to patient centeredness. JAMA Intern Med. 2013;173(3):218–9. https://doi.org/10.1001/jamainternmed.2013.1229.

    Article  PubMed  Google Scholar 

  21. Naik AD, Walling AM. Getting patients ready for “in the moment” decisions. Wiley Online Library; 2022. p. 2474–7.

    Google Scholar 

  22. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Damasio A. The neurobiological grounding of human values. In: Neurobiology of human values. Springer; 2005. p. 47–56.

    Chapter  Google Scholar 

  24. 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.

    Google Scholar 

  25. Reyna VF. How people make decisions that involve risk: a dual-processes approach. Curr Dir Psychol Sci. 2004;13(2):60–6.

    Article  Google Scholar 

  26. Naik AD, McCullough LB. Health intuitions inform patient-centered care. Am J Bioeth. 2014;14(6):1–3.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. Locke EA, Latham GP. The development of goal setting theory: a half century retrospective. Motiv Sci. 2019;5(2):93.

    Article  Google Scholar 

  30. Wade DT. Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil. 2009;23(4):291–5.

    Article  PubMed  Google Scholar 

  31. 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.

  32. 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.

    Article  PubMed  Google Scholar 

  33. Feder SL, Kiwak E, Costello D, et al. Perspectives of patients in identifying their values-based health priorities. J Am Geriatr Soc. 2019.

    Google Scholar 

  34. 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.

  35. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

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Correspondence to Aanand D. Naik .

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© 2024 This is a U.S. Government work and not under copyright protection in the U.S.; foreign copyright protection may apply

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Naik, A.D. (2024). 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/10.1007/978-3-030-74720-6_2

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  • DOI: https://doi.org/10.1007/978-3-030-74720-6_2

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  • Print ISBN: 978-3-030-74719-0

  • Online ISBN: 978-3-030-74720-6

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