Med Decis Making - Participation of very old adults in health care decisions.

Tópicos

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Resumo

CKGROUND: Some elderly people receive tests or interventions from which they have low likelihood of benefit or for which the goal is not aligned with their values. Engaging these patients in the decision process is one potential approach to improve the individualization of care. Yet some clinicians perceive and some survey data suggest that older adults prefer not to participate in the decision-making process. Those preferences, however, may be formed based on an experience in which factors, such as communication issues, were barriers to participation. Our goal was to shed light on the experience of very old adults in health care decision making from their own point of view to deepen our understanding of their potentially modifiable barriers to participation.DESIGN: andMETHODS: Semistructured interviews of participants aged 80 and older (n = 29, 59% women and 21% black) were analyzed using the constant comparative method in a grounded theory approach to describe decision making in clinic visits from the patient's perspective.RESULTS: The average age was 84 years (range, 80-93); each described an average of 6.4 decision episodes. Active participation was highly variable among subjects. Marked differences in participation across participants and by type of decision--surgery, medications, diagnostic procedures, routine testing for preventive care--highlighted barriers to greater participation. The most common potentially modifiable barriers were the perception that there were no options to consider, low patient activation, and communication issues.CONCLUSIONS: The experience of very old adults highlights potentially modifiable barriers to greater participation in decision making. To bring very old patients into the decision process, clinicians must modify interviewing skills and spend additional time eliciting their values, goals, and preferences.

Resumo Limpo

ckground elder peopl receiv test intervent low likelihood benefit goal align valu engag patient decis process one potenti approach improv individu care yet clinician perceiv survey data suggest older adult prefer particip decisionmak process prefer howev may form base experi factor communic issu barrier particip goal shed light experi old adult health care decis make point view deepen understand potenti modifi barrier participationdesign andmethod semistructur interview particip age older n women black analyz use constant compar method ground theori approach describ decis make clinic visit patient perspectiveresult averag age year rang describ averag decis episod activ particip high variabl among subject mark differ particip across particip type decisionsurgeri medic diagnost procedur routin test prevent carehighlight barrier greater particip common potenti modifi barrier percept option consid low patient activ communic issuesconclus experi old adult highlight potenti modifi barrier greater particip decis make bring old patient decis process clinician must modifi interview skill spend addit time elicit valu goal prefer

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