Refining a Taxonomy of Goals for Older Adults With Functional Limitations and Their Caregivers to Inform Care Planning

Clair, Catherine A; Henry, Maureen; Jennings, Lee A.; Reuben, David B.; Sandberg, Shana F.; Giovannetti, Erin R.

doi:10.1177/0733464820944326

Cited by 6 publications

(15 citation statements)

References 27 publications

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“…40 Approaches to identifying patients' goals have been reported for specific health problems or patient populations. [18][19][20][21][22][23][24][25][26][27][28][29] A goal taxonomy recently was developed for persons with functional limitations and complex care needs. 26,27 The patient priorities identification process builds on these efforts, particularly goal attainment scaling, by implementing a process that facilitates the separate identification of value-based outcome goals and health care preferences for persons with MCCs.…”

Section: Jama Network Open | Geriatricsmentioning

confidence: 99%

“…[18][19][20][21][22][23][24][25][26][27][28][29] A goal taxonomy recently was developed for persons with functional limitations and complex care needs. 26,27 The patient priorities identification process builds on these efforts, particularly goal attainment scaling, by implementing a process that facilitates the separate identification of value-based outcome goals and health care preferences for persons with MCCs. 30 This separation supports clinical decision-making by focusing decision-making on the achievement of each person's outcome goals within the context of the health care the individual is willing and able to receive.…”

Section: Jama Network Open | Geriatricsmentioning

confidence: 99%

“…5,9,[13][14][15][16][17] Most tools available for eliciting patients' goals and preferences were developed in the context of advanced illness or specific conditions or populations. [18][19][20][21][22][23][24][25][26][27][28][29] Some of these approaches may be less useful to older adults weighing the benefits, burdens, and tradeoffs associated with long-term management of several chronic conditions. Goal attainment scaling is appropriate for this latter population, although some applications include goal categories representing medical and supportive care, which are better considered care preferences that support attainment of desired life goals.…”

Section: Introductionmentioning

confidence: 99%

“…Goal attainment scaling is appropriate for this latter population, although some applications include goal categories representing medical and supportive care, which are better considered care preferences that support attainment of desired life goals. [22][23][24][25][26][27][28][29] In response to the need for approaches that support the alignment of clinical decision-making with the priorities of older adults with MCCs, a diverse group of patients, health care systems experts, and clinicians developed Patient Priorities Care (PPC). 13,14 Aimed at both patients and clinicians, PPC begins with a structured process in which patients work with a member of the health care team to identify the outcome goals that they most desire to achieve based on what matters most to them (ie, their values-based outcome goals) and to specify what they are willing (or unwilling) to do to achieve those outcomes (ie, their health care preferences).…”

Section: Introductionmentioning

confidence: 99%

“…The aim of the present study is to describe the outcome goals and health care preferences identified by older adults in this study. 26…”

Section: Introductionmentioning

confidence: 99%

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Outcome Goals and Health Care Preferences of Older Adults With Multiple Chronic Conditions

et al. 2021

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Key Points Question What are the common goals and health care preferences of older adults with multiple health conditions? Findings In this cross-sectional study, 163 older adults reported 459 goals, most commonly encompassing activities with family and friends (24.2%), shopping (6.1%), exercising (4.6%), and living independently (4.4%). Medications most commonly cited as helpful were nonopioid pain medications (65.5% of users), sleep medications (52.9% of users), and inhalants (42.2% of users), whereas statins (25.8% of users) and antidepressants (32.5% of users) were the most commonly reported bothersome medications. Meaning Participants identified realistic and doable goals and health care preferences; this information can inform decision-making.

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Section: Jama Network Open | Geriatricsmentioning

confidence: 99%

Section: Jama Network Open | Geriatricsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The aim of the present study is to describe the outcome goals and health care preferences identified by older adults in this study. 26…”

Section: Introductionmentioning

confidence: 99%

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Outcome Goals and Health Care Preferences of Older Adults With Multiple Chronic Conditions

et al. 2021

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Patient Priorities–Aligned Care for Older Adults With Multiple Conditions

Tinetti,

Hashmi,

et al. 2024

JAMA Netw Open

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ImportanceOlder adults with multiple conditions receive health care that may be burdensome, of uncertain benefit, and not focused on what matters to them. Identifying and aligning care with patients’ health priorities may improve outcomes.ObjectiveTo assess the association of receiving patient priorities care (PPC) vs usual care (UC) with relevant clinical outcomes.Design, Setting, and ParticipantsIn this nonrandomized controlled trial with propensity adjustment, enrollment occurred between August 21, 2020, and May 14, 2021, with follow-up continuing through February 26, 2022. Patients who were aged 65 years or older and with 3 or more chronic conditions were enrolled at 1 PPC and 1 UC site within the Cleveland Clinic primary care multisite practice. Data analysis was performed from March 2022 to August 2023.InterventionHealth professionals at the PPC site guided patients through identification of values, health outcome goals, health care preferences, and top priority (ie, health problem they most wanted to focus on because it impeded their health outcome goal). Primary clinicians followed PPC decisional strategies (eg, use patients’ health priorities as focus of communication and decision-making) to decide with patients what care to stop, start, or continue.Main Outcomes and MeasuresMain outcomes included perceived treatment burden, Patient-Reported Outcomes Measurement Information System (PROMIS) social roles and activities, CollaboRATE survey scores, the number of nonhealthy days (based on healthy days at home), and shared prescribing decision quality measures. Follow-up was at 9 months for patient-reported outcomes and 365 days for nonhealthy days.ResultsA total of 264 individuals participated, 129 in the PPC group (mean [SD] age, 75.3 [6.1] years; 66 women [48.9%]) and 135 in the UC group (mean [SD] age, 75.6 [6.5] years; 55 women [42.6%]). Characteristics between sites were balanced after propensity score weighting. At follow-up, there was no statistically significant difference in perceived treatment burden score between groups in multivariate models (difference, −5.2 points; 95% CI, −10.9 to −0.50 points; P = .07). PPC participants were almost 2.5 times more likely than UC participants to endorse shared prescribing decision-making (adjusted odds ratio, 2.40; 95% CI, 0.90 to 6.40; P = .07), and participants in the PPC group experienced 4.6 fewer nonhealthy days (95% CI, −12.9 to −3.6 days; P = .27) compared with the UC participants. These differences were not statistically significant. CollaboRATE and PROMIS Social Roles and Activities scores were similar in the 2 groups at follow-up.Conclusions and RelevanceThis nonrandomized trial of priorities-aligned care showed no benefit for social roles or CollaboRATE. While the findings for perceived treatment burden and shared prescribing decision-making were not statistically significant, point estimates for the findings suggested that PPC may hold promise for improving these outcomes. Randomized trials with larger samples are needed to determine the effectiveness of priorities-aligned care.Trial RegistrationClinicalTrials.gov Identifier: NCT04510948

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Harmonizing Emotions: An AI-Driven Sound Therapy System Design for Enhancing Mental Health of Older Adults

Shi,

Ma,

Wang

et al. 2024

Lecture Notes in Computer Science

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Refining a Taxonomy of Goals for Older Adults With Functional Limitations and Their Caregivers to Inform Care Planning

Cited by 6 publications

References 27 publications

Outcome Goals and Health Care Preferences of Older Adults With Multiple Chronic Conditions

Outcome Goals and Health Care Preferences of Older Adults With Multiple Chronic Conditions

Patient Priorities–Aligned Care for Older Adults With Multiple Conditions

Harmonizing Emotions: An AI-Driven Sound Therapy System Design for Enhancing Mental Health of Older Adults

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