Perspectives of Patients in Identifying Their Values‐Based Health Priorities

Abstract

OBJECTIVES Patient Health Priorities Identification (PHPI) is a values‐based process in which trained facilitators assist older adults with multiple chronic conditions identify their health priorities. The purpose of this study was to evaluate patients’ perceptions of PHPI. DESIGN Qualitative study using thematic analysis. SETTING In‐depth semistructured telephone and in‐person interviews. PARTICIPANTS Twenty‐two older adults who participated in the PHPI process. MEASUREMENTS Open‐ended questions about patient perceptions of the PHPI process, perceived benefits of the process, enablers and barriers to PHPI, and recommendations for process enhancement. RESULTS Patient interviews ranged from 9 to 63 minutes (median = 20 min; interquartile range = 15–26). The mean age was 80 years (standard deviation = 7.96), 64% were female, and all patients identified themselves as white. Of the sample, 73% reported no caregiver involvement in their healthcare; 36% lived alone. Most patients felt able to complete the PHPI process with ease. Perceived benefits included increased knowledge and insight into disease processes and treatment options, patient activation, and enhanced communication with family and clinicians. Patients identified several factors that were both enablers and barriers to PHPI including facilitator characteristics, patient demographic and clinical characteristics, social support, relationships between the patient and their primary care provider, and the changing health priorities of the patient. Recommendations for process enhancement included more frequent and flexible facilitator contacts, selection of patients for participation based on specific patient characteristics, clarification of process aims and expectations, involvement of family, written reminders of established health priorities, short duration between facilitation and primary care provider follow‐up, and the inclusion of health‐related tasks in facilitation visits. CONCLUSIONS Patients found the PHPI process valuable in identifying actionable health priorities and healthcare goals leading to enhanced knowledge, activation, and communication regarding their treatment options and preferences. PHPI may be useful for aligning the healthcare that patients receive with their values‐based priorities.

Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review

“…They also reported that initial fear among physicians that patients would formulate unrealistic goals was unjustified; if patient were guided through the SDM process, they formulated personal and realistic goals. This was confirmed by the study of Feder (2019) who also found that discussing personal goals led to a better relationship with physicians [76].…”

Older Adults’ Experiences of Goals in Health: A Systematic Review and Metasynthesis

“…Table 1 incorporates the characteristics and quality appraisal of the included studies. There were n = 764 participants (age range: 65-100 years, M: 78 years; 64% female) included in the 15 studies, three mixed methods studies (Melville et al, 2002;Rose et al, 2019;Saajanaho et al, 2016) and 12 qualitative studies (Brown et al, 2014;Coylewright et al, 2016;Efraimsson et al, 2006;Feder et al, 2019;Gorawara-Bhat et al, 2008;Hjelle et al, 2016;Huang et al, 2005;Kuluski et al, 2013;Pikkarainen et al, 2018;Schellinger et al, 2018;Schulman-Green et al, 2006;van Seben et al, 2019). Most studies chose purposive sampling.…”

“…Most studies chose purposive sampling. Data collection was via interviews (Brown et al, 2014;Efraimsson et al, 2006;Feder et al, 2019;Gorawara-Bhat et al, 2008;Hjelle et al, 2016;Huang et al, 2005;Kuluski et al, 2013;van Seben et al, 2019), questionnaires (Saajanaho et al, 2016;Schulman-Green et al, 2006), or a combination of both (Coylewright et al, 2016;Melville et al, 2002;Rose et al, 2019). Pikkarainen et al (2018) used nonparticipant observation, and Schellinger et al (2018) analyzed the data from electronic medical records that had documented direct patient quotes or patient validated statements.…”

Measuring Adoption of Patient Priorities–Aligned Care Using Natural Language Processing of Electronic Health Records: Development and Validation of the Model

“…This study opens 3 new avenues for further investigation. By identifying PPC notes, we can longitudinally assess care for patients throughout VA facilities and understand changes in health care delivered after PPC encounters [ 6 , 21 ]. We can identify patterns and consistency in how social workers and other clinicians document patient priorities over the course of multiple interactions with patients [ 3 ].…”