Perspectives of Patients in Identifying Their Values-Based Health Priorities
被引:18
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作者:
Feder, Shelli L.
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机构:
Yale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USAYale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
Feder, Shelli L.
[1
]
Kiwak, Eliza
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机构:
Yale Sch Med, Dept Med, New Haven, CT 06520 USAYale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
Kiwak, Eliza
[2
]
Costello, Darce
论文数: 0引用数: 0
h-index: 0
机构:
Yale Sch Med, Dept Med, New Haven, CT 06520 USAYale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
Costello, Darce
[2
]
Dindo, Lilian
论文数: 0引用数: 0
h-index: 0
机构:
Michael E DeBakey VA Med Ctr, Houston Ctr Innovat Qual Effectiveness & Safety I, Houston, TX USA
Baylor Coll Med, Houston, TX 77030 USAYale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
Dindo, Lilian
[3
,4
]
Hernandez-Bigos, Kizzy
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机构:
Connecticut Ctr Primary Care, Hartford, CT USAYale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
Hernandez-Bigos, Kizzy
[5
]
Vo, Lauren
论文数: 0引用数: 0
h-index: 0
机构:
Connecticut Ctr Primary Care, Hartford, CT USAYale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
Vo, Lauren
[5
]
Geda, Mary
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机构:
Yale Sch Med, Dept Med, New Haven, CT 06520 USAYale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
Geda, Mary
[2
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Blaum, Caroline
论文数: 0引用数: 0
h-index: 0
机构:
NYU, Sch Med, New York, NY USAYale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
Blaum, Caroline
[6
]
Tinetti, Mary E.
论文数: 0引用数: 0
h-index: 0
机构:
Yale Sch Med, Dept Med, New Haven, CT 06520 USA
Yale Sch Publ Hlth, Dept Chron Dis Epidemiol, New Haven, CT 06520 USAYale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
Tinetti, Mary E.
[2
,7
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Naik, Aanand D.
论文数: 0引用数: 0
h-index: 0
机构:
Michael E DeBakey VA Med Ctr, Houston Ctr Innovat Qual Effectiveness & Safety I, Houston, TX USA
Baylor Coll Med, Houston, TX 77030 USAYale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
Naik, Aanand D.
[3
,4
]
机构:
[1] Yale Sch Med, Natl Clinician Scholars Program, POB 208088, New Haven, CT 06520 USA
[2] Yale Sch Med, Dept Med, New Haven, CT 06520 USA
[3] Michael E DeBakey VA Med Ctr, Houston Ctr Innovat Qual Effectiveness & Safety I, Houston, TX USA
[4] Baylor Coll Med, Houston, TX 77030 USA
[5] Connecticut Ctr Primary Care, Hartford, CT USA
[6] NYU, Sch Med, New York, NY USA
[7] Yale Sch Publ Hlth, Dept Chron Dis Epidemiol, New Haven, CT 06520 USA
OBJECTIVES Patient Health Priorities Identification (PHPI) is a values-based process in which trained facilitators assist older adults with multiple chronic conditions identify their health priorities. The purpose of this study was to evaluate patients' perceptions of PHPI. DESIGN Qualitative study using thematic analysis. SETTING In-depth semistructured telephone and in-person interviews. PARTICIPANTS Twenty-two older adults who participated in the PHPI process. MEASUREMENTS Open-ended questions about patient perceptions of the PHPI process, perceived benefits of the process, enablers and barriers to PHPI, and recommendations for process enhancement. RESULTS Patient interviews ranged from 9 to 63 minutes (median = 20 min; interquartile range = 15-26). The mean age was 80 years (standard deviation = 7.96), 64% were female, and all patients identified themselves as white. Of the sample, 73% reported no caregiver involvement in their healthcare; 36% lived alone. Most patients felt able to complete the PHPI process with ease. Perceived benefits included increased knowledge and insight into disease processes and treatment options, patient activation, and enhanced communication with family and clinicians. Patients identified several factors that were both enablers and barriers to PHPI including facilitator characteristics, patient demographic and clinical characteristics, social support, relationships between the patient and their primary care provider, and the changing health priorities of the patient. Recommendations for process enhancement included more frequent and flexible facilitator contacts, selection of patients for participation based on specific patient characteristics, clarification of process aims and expectations, involvement of family, written reminders of established health priorities, short duration between facilitation and primary care provider follow-up, and the inclusion of health-related tasks in facilitation visits. CONCLUSIONS Patients found the PHPI process valuable in identifying actionable health priorities and healthcare goals leading to enhanced knowledge, activation, and communication regarding their treatment options and preferences. PHPI may be useful for aligning the healthcare that patients receive with their values-based priorities.
机构:
Yale Sch Med, Sect Geriatr, New Haven, CT 06510 USAYale Sch Med, Sect Geriatr, New Haven, CT 06510 USA
Ouellet, Gregory M.
Kiwak, Eliza
论文数: 0引用数: 0
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机构:
Yale Sch Med, Sect Geriatr, New Haven, CT 06510 USAYale Sch Med, Sect Geriatr, New Haven, CT 06510 USA
Kiwak, Eliza
Costello, Darce M.
论文数: 0引用数: 0
h-index: 0
机构:
Yale Sch Med, Program Aging, New Haven, CT USAYale Sch Med, Sect Geriatr, New Haven, CT 06510 USA
Costello, Darce M.
Green, Ariel R.
论文数: 0引用数: 0
h-index: 0
机构:
Johns Hopkins Univ, Sch Med, Div Geriatr Med & Gerontol, Baltimore, MD USAYale Sch Med, Sect Geriatr, New Haven, CT 06510 USA
Green, Ariel R.
Geda, Mary
论文数: 0引用数: 0
h-index: 0
机构:
Yale Sch Med, Program Aging, New Haven, CT USAYale Sch Med, Sect Geriatr, New Haven, CT 06510 USA
Geda, Mary
Naik, Aanand D.
论文数: 0引用数: 0
h-index: 0
机构:
Michael E DeBakey VA Med Ctr, Houston Ctr Innovat Qual Effectiveness & Safety I, Houston, TX USA
Baylor Coll Med, Dept Med Hlth Serv Res & Geriatr, Houston, TX 77030 USAYale Sch Med, Sect Geriatr, New Haven, CT 06510 USA
Naik, Aanand D.
Tinetti, Mary E.
论文数: 0引用数: 0
h-index: 0
机构:
Yale Sch Med, Sect Geriatr, New Haven, CT 06510 USAYale Sch Med, Sect Geriatr, New Haven, CT 06510 USA
机构:
Univ New S Wales, Australian Inst Hlth Innovat, Ctr Clin Governance Res, Sydney, NSW, AustraliaUniv New S Wales, Australian Inst Hlth Innovat, Ctr Clin Governance Res, Sydney, NSW, Australia
Braithwaite, Jeffrey
Skinner, Clare A.
论文数: 0引用数: 0
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机构:
Royal N Shore Hosp, Sydney, NSW, AustraliaUniv New S Wales, Australian Inst Hlth Innovat, Ctr Clin Governance Res, Sydney, NSW, Australia
Skinner, Clare A.
Doeery, Mei Ling
论文数: 0引用数: 0
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机构:
Victorian Hlth Promot Fdn, Board Governance, Melbourne, Vic, AustraliaUniv New S Wales, Australian Inst Hlth Innovat, Ctr Clin Governance Res, Sydney, NSW, Australia
机构:Univ Glamorgan, Welsh Inst Hlth & Social Care, Pontypridd CF37 1DL, M Glam, Wales
Fulford, KWM
Williams, R
论文数: 0引用数: 0
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机构:
Univ Glamorgan, Welsh Inst Hlth & Social Care, Pontypridd CF37 1DL, M Glam, WalesUniv Glamorgan, Welsh Inst Hlth & Social Care, Pontypridd CF37 1DL, M Glam, Wales