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Primary Care Clinicians' Experiences With Treatment Decision Making for Older Persons With Multiple Conditions
Open accessAbstract
BACKGROUND: Clinicians are caring for an increasing number of older patients with multiple diseases in the face of uncertainty concerning the benefits and harms associated with guideline-directed interventions. Understanding how primary care clinicians approach treatment decision making for these patients is critical to the design of interventions to improve the decision-making process. METHODS: Focus groups were conducted with 40 primary care clinicians (physicians, nurse practitioners, and physician assistants) in academic, community, and Veterans Affairs-affiliated primary care practices. Participants were given open-ended questions about their approach to treatment decision making for older persons with multiple medical conditions. Responses were organized into themes using qualitative content analysis. RESULTS: The participants were concerned about their patients' ability to adhere to complex regimens derived from guideline-directed care. There was variability in beliefs regarding, and approaches to balancing, the benefits and harms of guideline-directed care. There was also variability regarding how the participants involved patients in the process of decision making, with clinicians describing conflicts between their own and their patients' goals. The participants listed a number of barriers to making good treatment decisions, including the lack of outcome data, the role of specialists, patient and family expectations, and insufficient time and reimbursement. CONCLUSIONS: The experiences of practicing clinicians suggest that they struggle with the uncertainties of applying disease-specific guidelines to their older patients with multiple conditions. To improve decision making, they need more data, alternative guidelines, approaches to reconciling their own and their patients' priorities, the support of their subspecialist colleagues, and an altered reimbursement system.
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“Fried et al. showed that clinicians struggle with the uncertainties of applying disease-specific guidelines to their patients with multiple conditions, and would therefore benefit from a number of tools to assist them in decision making for this population [12].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [12]
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ResultSelf-citationViews of Older Persons with Multiple Morbidities on Competing Outcomes and Clinical Decision‐Making
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ResultSelf-citationPitfalls of Converting Practice Guidelines Into Quality Measures
Walter, L. C., Davidowitz, N. P., Heineken, P. A., & Covinsky, K. E. (2004) · JAMA · doi:10.1001/jama.291.20.2466 · Cited by 197
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“There are also implications for clinicians who struggle to balance the requirements of several guidelines for multimorbid patients, hindered by the lack of outcome data.(18) One significant consequence of following multiple guidelines is the concurrent prescribing of multiple medications.”
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“In general, vulnerable patients might receive fewer preventive drugs than fit older people [21,22], although, ultimately, vulnerability should not be viewed as a reason to withhold care, but rather as a means of delivering it in a more patient-centred fashion [23] For secondary cardiovascular preventive medication thi…”
BackgroundPatterns and Stability over Time of Older Adults’ Diabetes-related Beliefs
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The geriatric gap: the absence of geriatric medicine in postgraduate medical training in Poland
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Metadata
- Authors
- Fried, T. R., Tinetti, M. E., & Iannone, L.
- Affiliations
- Yale University (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2010-09-13
- Volume
- 171
- Issue
- 1
- Pages
- 75-80
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC3021478
- OpenAlex
- W2012018261
- Cited by
- 236
- References
- 28
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 7 · 2023: 11 · 2022: 12 · 2021: 10 · 2020: 15 · 2019: 24 · 2018: 15 · 2017: 22 · 2016: 22 · 2015: 15 · 2014: 23 · 2013: 18 · 2012: 24
- FWCI
- 12.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Yale University (P30AG21342)
- National Institutes of Health
- National Institute on Aging (K24AG028443, P30 AG21342, P30AG021342)
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- treatment decision-making, older adults, multimorbidity, primary care providers, guideline-directed care, medication adherence, benefits and harms, shared decision-making, barriers to decision-making, reimbursement, clinician beliefs
- MeSH terms
- Workforce, Adult, Aged, Chronic Disease, Connecticut, Decision Making, Female, Goals, Hospitals, University, Humans, Male, Middle Aged, Nurse Practitioners, Patient Compliance, Practice Patterns, Physicians', Physician Assistants, Primary Health Care, Residence Characteristics, United States, Comorbidity, Focus Groups, Narration, Qualitative Research, Medication Adherence, Physicians, Primary Care
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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