<p>Methods to Assess Patient Preferences in Old Age Pharmacotherapy – A Systematic Review</p>

Abstract

Purpose: The aim of this systematic review was to identify methods used to assess medication preferences in older adults and evaluate their advantages and disadvantages with respect to their applicability to the context of multimorbidity and polypharmacy. Material and Methods: Three electronic databases (PubMed, Web of Science, PsycINFO) were searched. Eligible studies elicited individual treatment or outcome preferences in a context that involved long-term pharmacological treatment options. We included studies with a study population aged ≥ 65 years and/or with a mean or median age of ≥ 75 years. Qualitative studies, studies assessing preferences for only two different treatments, and studies targeting preferences for life-sustaining treatments were excluded. The identified preference measurement methods were evaluated based on four criteria (time budget, cognitive demand, variety of pharmacological aspects, and link with treatment strategies) judged to be relevant for the elicitation of patient preferences in polypharmacy. Results: Sixty articles met the eligibility criteria and were included in the narrative synthesis. Fifty-five different instruments to assess patient preferences, based on 24 different elicitation methods, were identified. The most commonly applied preference measurement techniques were "medication willingness" (description of a specific medication with inquiry of the participant's willingness to take it), discrete choice experiments, Likert scale-based questionnaires, and rank prioritization. The majority of the instruments were created for disease-specific or context-specific settings. Only three instruments (Outcome Prioritization Tool, a complex intervention, "MediMol" questionnaire) dealt with the broader issue of geriatric multimorbidity. Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy. Conclusion: Up to now, few instruments have been specifically designed for the assessment of medication preferences in older patients with multimorbidity. To facilitate valid preference elicitation in the context of geriatric polypharmacy, future research should focus on suitable characteristics of existing techniques to develop new measurement approaches for this increasingly relevant population.

Development of an Electronic Tool to Assess Patient Preferences in Geriatric Polypharmacy (PolyPref)

“…Only few strategies have been developed and evaluated for the assessment of medication preferences in geriatric multimorbidity. 8 In addition to preference instruments focusing specifically on polypharmacy, a number of studies have touched on medication-related patient priorities as part of larger interventions aimed at providing patient-centered care for older individuals with multiple chronic conditions. [39][40][41] Recently, an approach called Patient Priorities Care has been introduced and studied in an ambulatory setting.…”

“… 7 Few measurement instruments have assessed medication preferences in the context of geriatric multimorbidity. 8 Examples include a discrete choice experiment evaluating the trade-offs between the risk of fall injury, symptomatic side effects, and the preventive benefits of antihypertensive drug therapy, 9 and a scenario-based approach to measure the patients’ willingness to take medication for the prevention of cardiovascular disease. 10 The so-called Outcome Prioritization Tool, which allows for prioritizing between four universal health outcomes, has been used in several different studies and employed as a starting point to propose medication changes in primary care patients.…”

Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study

“…Yet beliefs linked to medication treatments are a gateway to understanding the patient rationales underpinning their daily medication use [ 20 ]. Furthermore, most scientific studies have concentrated on specific illnesses and medications in order to explore particular non-adherent behaviours [ 17 ] and patient preferences [ 35 ]. Yet experiences of medication practices and the beliefs that surround them seem to go beyond specific types of medication for chronic illnesses [ 17 , 36 ].…”

Assessing the perspective of well-being of older patients with multiple morbidities by using the LAVA tool - a person-centered approach

“…treatment yes/ no). A recent review regarding preferences in old age pharmacotherapy reported that out of 55 identified instruments the majority of these were designed to assess a patient's preferences in a disease-specific context while only three questionnaires accounted for multimorbidity [7]. Furthermore, only a limited number of these tools focus on prioritization of health outcomes [8].…”