How to ask: Older adults’ preferred tools in health outcome prioritization

Abstract

OBJECTIVE To assess older adults’ attitudes toward eliciting health outcome priorities. METHODS This observational cohort study of 356 community-living adults age ≥ 65 included three tools: 1) Health Outcomes: ranking four outcomes (survival, function, freedom from pain, and freedom from other symptoms); 2) Now vs. Later: rating importance of current versus future quality of life; 3) Attitude Scale: agreement with statements about health outcomes and current versus future health. RESULTS Whereas 41% preferred Health Outcomes, 40% preferred the Attitude Scale. Only 7–12% rated any tool as very hard or hard. In bivariate analysis, participants of non-white race and with lower education, health literacy, and functional status were significantly more likely to rate at least one of the tools as easy (p<0.05). Across all tools, 17% of participants believed tools would change care. The main reason for thinking there would be no change was satisfaction with existing care (62%). CONCLUSIONS There is variability in how older persons wish to be asked about health outcome priorities. Few find this task difficult, and difficulty was not greater among participants with lower health literacy, education, or health status. PRACTICE IMPLICATIONS By offering different tools, healthcare providers can help patients clarify their health outcome priorities.

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

“…The Present vs. Future Health Prioritization tool adds a level of detail by asking people to take into account the time at which an outcome occurs. It displays two VASs on which participants rate the importance of their present QOL versus QOL at both one and five years in the future(27). A score of 50 indicates equal importance of present and future QOL, while scores >50 favor present QOL and scores <50 favor future QOL.…”

“…While decision analysis and multi-attribute theory are well established approaches to elicit universal outcome priorities (22, 23), these methods are complex, and, when used by older adults, frequently yield inconsistent results (24, 25). The tools in this study were developed based on how older adults naturally think about tradeoffs (26) and have been shown to be easy and reliable for use with older adults (27). The purpose of our study was to investigate whether individuals’ health outcome priorities can identify their willingness to take a medication that reduces the risk of myocardial infarction (MI) but also causes adverse effects.…”

Considering the Balance: Development of a Scale to Assess Patient Views on Trade‐Offs in Competing Health Outcomes

“…The use of the scale in clinical care and research depends upon better understanding of the reason(s) for the only modest test–retest reliability. Although modest reliability may represent weaknesses in scale construction, it could also reflect better understanding of the trade‐offs after repeated exposure to the items, which some individuals may not have previously considered . It may also represent evolving values resulting from changes in the individual's health status.…”

“…In the meantime, this scale may facilitate conversations about trade‐offs in medical decisions. Presenting multiple statements about trade‐offs can provide an introduction to concepts that people may find challenging to articulate . Although the scale alone is insufficient to assess choices from among competing outcomes, it could open a dialogue about values between patients and providers.…”

“…One outcome, “keeping you alive,” corresponds to quantity of life, and “maintaining independence,” “reducing or eliminating pain,” and “reducing or eliminating other symptoms including dizziness, fatigue, and shortness of breath,” correspond to QOL. The Now versus Later tool asks participants to indicate the importance of “My Quality of Life” on two VASs, comparing “now” at one end with “1 year from now” and “5 years from now” at the other . The scoring was constructed so that a value of 50 indicated equal importance of current and future QOL, less than 50 indicated that current QOL was less important than future QOL, and greater than 50 indicated that current QOL was more important than future QOL.…”