Complex health care decisions with older patients in general practice: Patient-centeredness and prioritization in consultations following a geriatric assessment

Wrede, J.; Voigt, Isabel; Bleidorn, Jutta; Hummers-Pradier, Eva; Dierks, Marie‐Luise; Junius-Walker, Ulrike

doi:10.1016/j.pec.2012.07.015

Cited by 25 publications

(38 citation statements)

References 28 publications

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“…The eight articles included in this review reported on five unique interventions. Based on these interventions, a distinction could be made between two articles reporting on the same underlying study on a single intervention concerning health priority setting, the PrefCheck [ 20 , 21 ], and four multifactorial interventions in which goal setting and/or priority setting are part of a broader intervention. Three of the four multifactorial interventions described the same underlying study on the effects of Guided Care (GC) [ 22 – 24 ].…”

Section: Resultsmentioning

confidence: 99%

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Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review

Vermunt¹,

Harmsen²,

Westert³

et al. 2017

BMC Geriatr

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BackgroundIt is challenging to use shared decision-making with patients who have a chronic health condition or, especially, multimorbidity. A patient-goal-oriented approach can thus be beneficial. This study aims to identify and evaluate studies on the effects of interventions that support collaborative goal setting or health priority setting compared to usual care for elderly people with a chronic health condition or multimorbidity.MethodsThis systematic review was based on EPOC, PRISMA and MOOSE guidelines. Pubmed, PsychInfo, CINAHL, Web of Science, Embase and the Cochrane Central Register of Controlled Trials were searched systematically. The following eligibility criteria were applied: 1. Randomised (cluster) controlled trials, non-randomised controlled trials, controlled before-after studies, interrupted time series or repeated measures study design; 2. Single intervention directed specifically at collaborative goal setting or health priority setting or a multifactorial intervention including these elements; 3. Study population of patients with multimorbidity or at least one chronic disease (mean age ± standard deviation (SD) incl. age 65). 4. Studies reporting on outcome measures reducible to outcomes for collaborative goal setting or health priority setting.ResultsA narrative analysis was performed. Eight articles describing five unique interventions, including four cluster randomised controlled trials and one randomised controlled trial, were identified. Four intervention studies, representing 904, 183, 387 and 1921 patients respectively, were multifactorial and showed statistically significant effects on the application of goal setting (Patient Assessment of Chronic Illness Care (PACIC) goal setting subscale), the number of advance directives or the inclusion of goals in care plans. Explicit attention for goal setting or priority setting by a professional was a common element in these multifactorial interventions. One study, which implemented a single-factor intervention on 322 patients, did not have significant effects on doctor-patient agreement. All the studies had methodological concerns in varying degrees.ConclusionsCollaborative goal setting and/or priority setting can probably best be integrated in complex care interventions. Further research should determine the mix of essential elements in a multifactorial intervention to provide recommendations for daily practice. In addition, the necessity of methodological innovation and the application of mixed evaluation models must be highlighted to deal with the complexity of goal setting and/or priority setting intervention studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0534-0) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…In the PrefCheck intervention, a trained GP holds a consultation based on a specially developed guide, the PrefCheck. After the patient rates the importance of each existing health problem, the patient and GP exchange and document health and treatment priorities [ 20 , 21 ].…”

Section: Resultsmentioning

confidence: 99%

Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review

Vermunt¹,

Harmsen²,

Westert³

et al. 2017

BMC Geriatr

View full text Add to dashboard Cite

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“…Of these, 4 (21.1%) included at least some mention of hearing loss. In two cases, these were mentions only, and one excluded patients with “severe” hearing loss . In one qualitative study, “physical barriers” (including hearing impairment) emerged as a key barrier for patient involvement in decision‐making …”

Section: Resultsmentioning

confidence: 99%

“…Of these, 4 (21.1%) included at least some mention of hearing loss. 55 None Peck (2011) 56 None Shields et al (2005) 57 None Song and Ward (2014) 58 None Wetzels et al (2004) 59 None Wolff and Roter (2012) 60 None Wrede et al (2013) 61 Exclusion. "Severe hearing loss" is an exclusion criterion.…”

Section: Construct #2: Shared Decision-making and A Patientcentered Amentioning

confidence: 99%

Studies of Physician‐Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review

Cohen

Blustein

Weinstein

et al. 2017

J American Geriatrics Society

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Hearing loss is remarkably prevalent in the geriatric population: one-quarter of adults aged 60-69 and 80% of adults aged 80 years and older have bilateral disabling loss. Only about one in five adults with hearing loss wears a hearing aid, leaving many vulnerable to poor communication with healthcare providers. We quantified the extent to which hearing loss is mentioned in studies of physician-patient communication with older patients, and the degree to which hearing loss is incorporated into analyses and findings. We conducted a structured literature search within PubMed for original studies of physician-patient communication with older patients that were published since 2000, using the natural language phrase "older patient physician communication." We identified 409 papers in the initial search, and included 67 in this systematic review. Of the 67 papers, only 16 studies (23.9%) included any mention of hearing loss. In six of the 16 studies, hearing loss was mentioned only; in four studies, hearing loss was used as an exclusion criterion; and in two studies, the extent of hearing loss was measured and reported for the sample, with no further analysis. Three studies examined or reported on an association between hearing loss and the quality of physician-patient communication. One study included an intervention to temporarily mitigate hearing loss to improve communication. Less than one-quarter of studies of physician-elderly patient communication even mention that hearing loss may affect communication. Methodologically, this means that many studies may have omitted an important potential confounder. Perhaps more importantly, research in this field has largely overlooked a highly prevalent, important, and remediable influence on the quality of communication.

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“…PDAs assist patients and clinicians to work through discrete screening, treatment and/or medication decisions, but do not appear to assist with broader decisional conflicts or processes such as prioritising conditions and goals for care; key decisions faced by clinicians and patients managing multiple conditions (135,217,415). Working through these broader decisional conflicts and prioritising conditions and goals for care is something that could be integrated in care plan development.…”

Section: Patient Decision Aidsmentioning

confidence: 99%

Is Australian primary care practice equipped to provide multimorbidity care?

Young¹

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Complex health care decisions with older patients in general practice: Patient-centeredness and prioritization in consultations following a geriatric assessment

Cited by 25 publications

References 28 publications

Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review

Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review

Studies of Physician‐Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review

Is Australian primary care practice equipped to provide multimorbidity care?

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