Majority of Older Adults Do Not Discuss Healthcare Priorities with Providers
Wednesday, July 29, 2015
If you’re an older adult who has multiple medical conditions, you often need to consider tradeoffs when you’re making decisions about various treatment options. In a new study published in the August issue of Journal of the American Geriatrics Society, participants were asked how—or if—they consider their options when deciding on a medical treatment.
In the study, researchers first asked 40 male and 10 female volunteers—aged 65 and older from a Veteran’s Administration healthcare system—to think about everyday healthcare decisions that would involve trade-offs. The participants were asked to rank various health outcomes such as living longer, staying independent, or relieving symptoms. They were also asked if they agreed with a series of statements asking them to weigh one outcome against another. For example, “I would rather live a shorter life than be unable to care for myself,” or “I am willing to have side effects right now if it means I can have a better quality of life in the future.”
After the first question, the researchers asked the participants whether they have had experiences considering their priorities and tradeoffs when making medical decisions. If the participant couldn’t think of an example, the researchers suggested one (for example, a person with high cholesterol taking a statin drug who experienced muscle pain severe enough to interfere with their ability to walk). Then the researchers asked the participants if they could come up with specific cases that would apply to them.
Almost all of the participants (88%) were able to describe healthcare decisions involving tradeoffs. Most involved surgery or end-of-life decision-making. Only a few participants described decisions about taking medications or making lifestyle changes to manage chronic illnesses.
When asked about discussions participants had involving their healthcare providers, most thought that their healthcare provider should know about their priorities—but only 36% reported having actual conversations with their provider about their preferences. The ability to have these types of talks with a healthcare provider and other members of your healthcare team is an important aspect of wellness. Indeed, the Centers for Medicare and Medicaid recently released proposed guidance for services it intends to cover in 2016, and advance care planning—a service involving these types of conversations in the context of end-of-life care—was included in the proposal.
“This study tells us that, while patients recognize trade-offs in decisions that involve major risks, such as surgery, they don’t always think about tradeoffs in day-to-day decisions. Patients should always ask their healthcare provider about the potential downsides to any proposed treatment as well as the other options that might be available.”
This summary is from “Older Adults’ Recognition of Tradeoffs in Healthcare Decision Making.” It appears online ahead of print in the August 2015 issue of the Journal of the American Geriatrics Society. The study authors are Siobhan M. Case, MD, MHS; John O’Leary, MA; Nancy Kim, MD, PhD; Mary E. Tinetti, MD and Terri R. Fried, MD.