Patient values in healthcare decision making among diverse older adults.
Andrea M Kurasz, Glenn E Smith, Rosie E Curiel and 4 others
PMID 34509339WHAT IT FOUND
Older adults, including people with mild cognitive impairment, described medical decisions as shaped by family advice, physician input, quality of life, side effects, cost, faith, and changing priorities as health declines.
Clinicians may need to ask explicitly and revisit values over time.
Key findings
01Participants reported global values such as personality traits, caregiver roles, preventative care, quality of life, and thinking about the future.
02Decisional values included personal and family medical history, effects on ability to do a job, plausibility of treatment, side effects, cost, and weighing tradeoffs.
03Participants said values affecting medical decision-making were not constant and changed with growing older, worsening health, near-death experiences, and watching friends die.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Participants were from one geographic region and were highly engaged in research, so the themes may not reflect older adults who cannot or do not participate in research. The sample did not reflect the diversity of the general older adult population. Comorbidities and overall health status were not collected beyond cognitive status. All participants had exposure to a large academic medical system, which may shape values about care settings and clinician credentials. The study was not designed to compare Hispanic/non-Hispanic or cognitive groups, and theme saturation was not assessed for subgroups. No participant checking was performed, so themes were not verified by participants. Preferences for the decision-making process were not systematically assessed.
Declared interests
Several authors reported none. Smith reported research support from the 1Florida Alzheimer’s Disease Research Center and the Florida Department of Health. Armstrong reported grant support from the NIA, the Florida Department of Health, and a Lewy Body Dementia Association Research Center of Excellence site, prior grant support from ARHQ and NIA, compensation from the American Academy of Neurology, and publishing royalties.
The easy way to misread this
Do not read these themes as proof that asking about values improves decisions, satisfaction, or health outcomes. This was a descriptive focus group study that reported themes, not effects.