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Chronic Disease Decision Making and "What Matters Most"
Terri R Fried1,2, Richard L Street3,4, Andrew B Cohen2
1Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut.
Journal of the American Geriatrics Society
|February 12, 2020
Summary
Understanding patient priorities is key for patient-centered care. However, translating these goals into treatment plans for chronic conditions, especially with multimorbidity, presents challenges for clinicians.
Area of Science:
- Geriatrics
- Patient-Centered Care
- Health Outcomes
Background:
- Patient-centered care emphasizes understanding patient priorities.
- Goal elicitation is crucial for navigating treatment trade-offs in chronic conditions.
- Older adults with multimorbidity face unique challenges in treatment planning.
Purpose of the Study:
- To explore the complexities of translating patient-centered goals into actionable treatment plans for older adults with chronic conditions.
- To identify challenges in using goal elicitation and decision aids for patients with multimorbidity and/or frailty.
- To propose methods for organizing complex patient profiles into identifiable trade-offs for care planning.
Main Methods:
- Qualitative analysis of challenges in goal elicitation for chronic disease management.
- Review of existing decision aid (DA) limitations for older adults.
- Conceptual framework development for managing multimorbidity and patient priorities.
Main Results:
- Translating patient goals into treatment plans for chronic conditions is complex.
- Lack of robust outcome data hinders decision aid development for older adults.
- Multimorbidity and cognitive impairment complicate goal elicitation and DA use.
- Organizing complex patient conditions into trade-offs is a significant challenge.
Conclusions:
- Effective patient-centered care for older adults with multimorbidity requires addressing complexities in goal elicitation and treatment planning.
- Further research is needed to develop better decision aids and data for this population.
- Integrating patient priorities with clinical guidelines necessitates innovative approaches to manage competing outcomes.
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