Development of a Clinically Feasible Process for Identifying Individual Health Priorities
See related editorial by William B. Applegate et al
Listen to the GeriPal Podcast with the author at https://geripal.org/identifying-what-patients-care-about/
Key definitions:
Health outcome goals are the health and life outcomes that people desire from their health care. To inform decision-making, goals should be specific, measurable, actionable, realistic, and timely (SMART) and aligned with what matters most to the individual (individual values).Healthcare preferences refer to healthcare activities (e.g., medications, self-management tasks, healthcare visits, diagnostic testing, procedures) that people are willing and able (or not willing or able) to perform and the care they are willing (or not willing) to receive.Patient's health priorities refer to the specific health outcome goals that individuals most desire from their health care given what they are willing and able to do to achieve these outcome goals (within the context of their healthcare preferences).
Abstract
Objectives
To develop a values-based, clinically feasible process to help older adults identify health priorities that can guide clinical decision-making.
Design
Prospective development and feasibility study.
Setting
Primary care practice in Connecticut.
Participants
Older adults with 3 or more conditions or taking 10 or more medications (N=64).
Intervention
The development team of patients, caregivers, and clinicians used a user-centered design framework—ideate → prototype → test →redesign—to develop and refine the value-based patient priorities care process and medical record template with trained clinician facilitators.
Measurements
We used descriptive statistics of quantitative measures (percentage accepted invitation and completed template, duration of process) and qualitative analysis of barriers and enablers (challenges and solutions identified, facilitator perceptions).
Results
We developed and refined a process for identifying patient health priorities that was typically completed in 35 to 45 minutes over 2 sessions; 64 patients completed the process. Qualitative analyses were used to elucidate the characteristics and training needed for the patient priorities facilitators, as well as perceived benefits and challenges of the process. Refinements based on our experience and feedback include streamlining the process for greater feasibility, balancing fidelity to the process while customizing to individuals, encouraging patients to share their priorities with their clinicians, and simplifying the template transmitted to clinicians.
Conclusion
Trained facilitators conducted this process in a busy primary care practice, suggesting that patient priorities identification is feasible and acceptable, although testing in additional settings is necessary. We hope to show that clinicians can align care with patients' health priorities.
