New elements for informed decision making: A qualitative study of older adults鈥?views

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• 作者：Erika Leemann Price^a ; ^{erika.price@ucsf.edu} ; Sylvia Bereknyei^b ; Alma Kuby^c ; Wendy Levinson^d ; Clarence Henry Braddock III^b
• 关键词：Informed decision making ; Shared decision making ; New elements for informed decision making ; Qualitative analysis ; Focus groups ; Older adults
• 刊名：Patient Education and Counseling
• 出版年：2012
• 期刊代码：217_07383991
• 类别：med
• 出版时间：March, 2012
• 卷：86
• 期：3
• 页码：335-341
• 文件大小：219 K

摘要

Objective

To explore older adults鈥?views of existing informed decision making (IDM) elements and investigate the need for additional elements.

Methods

We recruited persons 65 and older to participate in six focus groups. Participants completed questionnaires about IDM preferences, and discussed videotapes of idealized patient-physician interactions in light of seven IDM elements: (1) discussion of the patient's role in decision making; (2) discussion of the clinical issue; (3) discussion of alternatives; (4) discussion of benefits/risks; (5) discussion of uncertainties; (6) assessment of patient understanding; and (7) exploration of patient preference. We used a modified grounded theory approach to assess agreement with existing IDM elements and identify new elements.

Results

In questionnaires, 97-100%of 59 participants rated each IDM element as 鈥渟omewhat鈥?or 鈥渧ery鈥?important. Qualitative analysis supported existing elements and suggested two more: opportunity for input from trusted others, and discussion of decisions鈥?impacts on patients鈥?daily lives. Elements overlapped with global communication themes.

Conclusion

Focus groups affirmed existing IDM elements and suggested two more with particular relevance for older patients.

Practice implications

Incorporation of additional IDM elements into clinical practice can enhance informed participation of older adults in decision making.