Views of Older Persons with Multiple Morbidities on Competing Outcomes and Clinical Decision‐Making
Open accessAbstract
OBJECTIVES: To examine the ways in which older persons with multiple conditions think about potentially competing outcomes in order to gain insight into how processes to elicit values regarding these outcomes can be grounded in the patient's perspective. DESIGN: Qualitative study consisting of purposefully sampled focus groups. SETTING: Community. PARTICIPANTS: Persons aged 65 and older taking five or more medications. MEASUREMENTS: Participants were asked their perceptions about whether their illnesses or treatment interacted with each other, goals of their treatment, and decisions to change or stop treatment. RESULTS: Although participants were largely unaware that treatment of one condition could worsen another, many had experience with adverse medication effects as a competing outcome. Participants initially discussed their conditions in terms of disease‐specific outcomes, such as achieving a target blood pressure or lipid level. In the context of decision‐making, participants shifted their discussion from disease‐specific to global, cross‐disease health outcomes, such as survival, preservation of physical function, and relief of symptoms. Despite having some misconceptions regarding the likelihood of these outcomes, they weighed the outcomes against one another to consider what was most important to them. Their preference was for the treatment that would achieve the most desired outcome. CONCLUSION: Because of their experience with adverse medication effects, older persons with multiple morbidities can understand the concept of competing outcomes. The task of prioritizing global, cross‐disease outcomes can help to clarify what is most important to seniors who are faced with complex healthcare decisions.
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Many older patients regard preserved function, independence, and related self-efficacy as their primary goals of care, and for many, conserved functional capabilities become more important than traditional disease-specific therapeutic end points.
“many older patients regard preserved function, independence, and related self-efficacy as their primary goals of care; that is, for many patients, conserved functional capabilities become more important than traditional disease-specific therapeutic end points.5”
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Cites
Wagner, H. R., Glaser, B. G., & Strauss, A. L. (1968) · Social Forces · doi:10.2307/2575405 · Cited by 46,470 · see citing works
Qualitative research. Introducing focus groups.
Kitzinger, J. (1995) · BMJ · doi:10.1136/bmj.311.7000.299 · Cited by 6,939 · see citing works
Decision aids for people facing health treatment or screening decisions
Stacey, D., Légaré, F., Lewis, K., Barry, M. J., Bennett, C. L., Eden, K. B., Holmes-Rovner, M., Llewellyn-Thomas, H., Lyddiatt, A., Thomson, R., et al. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001431.pub5 · Cited by 6,685 · see citing works
Risk Factors for Falls among Elderly Persons Living in the Community
Tinetti, M. E., Speechley, M. R., & Ginter, S. F. (1988) · New England Journal of Medicine · doi:10.1056/nejm198812293192604 · Cited by 6,507 · see citing works
Self-citationBoyd, C. M., Darer, J., Boult, C., Fried, L. P., Boult, L., & Wu, A. W. (2005) · JAMA · doi:10.1001/jama.294.6.716 · Cited by 2,581 · see citing works
Value-Focused Thinking: A Path to Creative Decisionmaking
Keeney, R. L. (1992) · Cited by 2,147 · see citing works
How to measure comorbiditya critical review of available methods
DEGROOT, V, BECKERMAN, H., LANKHORST, G., & BOUTER, L. (2003) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(02)00585-1 · Cited by 1,757 · see citing works
The pre-therapeutic classification of co-morbidity in chronic disease
Feinstein, A. R. (1970) · Journal of Chronic Diseases · doi:10.1016/0021-9681(70)90054-8 · Cited by 1,544 · cited 1× · see citing works
“Patients with multiple conditions are at high risk of adverse outcomes, including mortality, hospitalization, and disability.(1,2) Although the development of disease-specific guidelines has led to improvements in outcomes for patients with individual conditions, the application of these guidelines to persons with mul…”
BackgroundNot all patients want to participate in decision making
Levinson, W. S., Kao, A. C., Kuby, A. M., & Thisted, R. A. (2005) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2005.04101.x · Cited by 1,103 · see citing works
Potential pitfalls of disease-specific guidelines for patients with multiple conditions.
Tinetti, M., Bogardus, S., & Agostini, J. V. (2004) · New England Journal of Medicine · doi:10.1056/nejmsb042458 · Cited by 969 · see citing works
Self-citationRisk Factors for Serious Injury During Falls by Older Persons in the Community
Tinetti, M. E., Doucette, J. T., Claus, E. B., & Marottoli, R. A. (1995) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1995.tb07396.x · Cited by 910 · see citing works
Self-citationResisting medicines: a synthesis of qualitative studies of medicine taking
Pound, P., Britten, N., Morgan, M., Yardley, L., Pope, C., Daker-White, G., & Campbell, R. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2004.11.063 · Cited by 868 · see citing works
Collecting and analysing qualitative data: issues raised by the focus group
Sim, J. (1998) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.1998.00692.x · Cited by 834 · see citing works
How People Make Decisions That Involve Risk
Reyna, V. F. (2004) · Current Directions in Psychological Science · doi:10.1111/j.0963-7214.2004.00275.x · Cited by 639 · see citing works
Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases
Bayliss, E. A. (2003) · The Annals of Family Medicine · doi:10.1370/afm.4 · Cited by 537 · see citing works
Misimagining the unimaginable: The disability paradox and health care decision making.
Ubel, P. A., Loewenstein, G., Schwarz, N., & Smith, D. (2005) · Health Psychology · doi:10.1037/0278-6133.24.4.s57 · Cited by 360 · see citing works
Use of Thiazolidinediones and Fracture Risk
Meier, C., KRAENZLIN, M. E., Bodmer, M., Jick, S. S., Jick, H., & Meier, C. R. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.8.820 · Cited by 353 · see citing works
Promoting Informed Choice: Transforming Health Care To Dispense Knowledge for Decision Making
Woolf, S. H., Chan, E. C. Y., Harris, R., Sheridan, S., Braddock, C. H., Kaplan, R. M., Krist, A. H., O'Connor, A. M. C., & Tunis, S. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-143-4-200508160-00010 · Cited by 353 · see citing works
Views of older adults on patient participation in medication-related decision making
Belcher, V. N., Fried, T., Agostini, J. V., & Tinetti, M. (2006) · Journal of general internal medicine · doi:10.1111/j.1525-1497.2006.00329.x · Cited by 279 · see citing works
Self-citationWhat Is the Best Dementia Screening Instrument for General Practitioners to Use?
Brodaty, H., Low, L., Gibson, L., & Burns, K. A. (2006) · American Journal of Geriatric Psychiatry · doi:10.1097/01.jgp.0000216181.20416.b2 · Cited by 276 · see citing works
Use of Alendronate and Risk of Incident Atrial Fibrillation in Women
Heckbert, S. R., Li, G., Cummings, S. R., Smith, N. L., & Psaty, B. M. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.8.826 · Cited by 198 · see citing works
Shared Medical Decision Making
Mcnutt, R. (2004) · JAMA · doi:10.1001/jama.292.20.2516 · Cited by 191 · see citing works
Kassirer, J. P., & Pauker, S. G. (1981) · New England Journal of Medicine · doi:10.1056/nejm198112103052409 · Cited by 186 · see citing works
The Relationship Between Number of Medications and Weight Loss or Impaired Balance in Older Adults
Agostini, J. V., Han, L., & Tinetti, M. E. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52467.x · Cited by 167 · see citing works
Self-citationProjection Bias in Medical Decision Making
Loewenstein, G. F. (2005) · Medical Decision Making · doi:10.1177/0272989x04273799 · Cited by 92 · see citing works
A Patient‐Centered Approach to Advance Medical Planning in the Nursing Home
Gillick, M., Berkman, S., & Cullen, L. (1999) · Journal of The American Geriatrics Society · doi:10.1111/j.1532-5415.1999.tb04582.x · Cited by 70 · see citing works
Shared Medical Decision-Making
Kaplan, R. M. (2008) · Springer eBooks · doi:10.1007/978-0-387-74045-4_10 · Cited by 57 · see citing works
Primary Prevention Drug Therapy: Can It Meet Patients' Requirements for Reduced Risk?
Naylor, C. D., Llewellyn-Thomas, H. A., Paterson, J. M., Carter, J. A., Basinski, A., Myers, M. G., Hardacre, G. D., Dunn, E. V., D'Agostino, R. B., & Wolf, P. A. (2002) · Medical Decision Making · doi:10.1177/0272989x0202200411 · Cited by 21 · see citing works
Are preferences for cyclooxygenase-2 inhibitors influenced by the certainty effect?
Fraenkel, L., Wittink, D. R., Concato, J., et al. (2004) · PubMed · Cited by 18 · see citing works
Seniors' preferences for cancer screening and medication use based on absolute risk reduction.
Murphy, D., Gahm, G., Santilli, S., North, P., Oliver, S., & Shapiro, H. (2002) · The journals of gerontology. Series A, Biological sciences and medical sciences · doi:10.1093/gerona/57.2.m100 · Cited by 16 · see citing works
Shared Medical Decision Making
Waggoner, J. R. (2005) · JAMA · doi:10.1001/jama.293.9.1058-a · Cited by 4 · see citing works
Frahn, A. L. (1997) · PubMed · Cited by 2 · see citing works
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Reeve, E., To, J., Hendrix, I., Shakib, S., Roberts, M. S., & Wiese, M. D. (2013) · Drugs & Aging · doi:10.1007/s40266-013-0106-8 · Cited by 536 · see citing works
Forman, D. E., Arena, R., Boxer, R., Dolansky, M. A., Eng, J. J., Fleg, J. L., Haykowsky, M., Jahangir, A., Kaminsky, L. A., Kitzman, D. W., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000483 · Cited by 319 · see citing works
Fried, T. R., Tinetti, M. E., & Iannone, L. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.318 · Cited by 236 · see citing works
“Moreover, other clinicians noted that the reduction in risk for a disease-specific outcome might not be what was most important to the patient, an observation supported by studies indicating that the adverse effects of medications may be as, if not more, important to patients than their primary effects.(20,21) Disagre…”
ResultSelf-citation
- Authors
- Fried, T. R., McGraw, S., Agostini, J. V., & Tinetti, M. E.
- Affiliations
- Yale University (US)
- Corresponding author
- Fried, Terri R.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2008-10
- Volume
- 56
- Issue
- 10
- Pages
- 1839-1844
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC2596278
- OpenAlex
- W2133166190
- Cited by
- 203
- References
- 32
- Citations by year
- 2026: 10 · 2025: 5 · 2024: 12 · 2023: 7 · 2022: 6 · 2021: 13 · 2020: 15 · 2019: 15 · 2018: 11 · 2017: 17 · 2016: 17 · 2015: 16 · 2014: 15 · 2013: 9 · 2012: 12
- FWCI
- 5.62
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Yale University
- National Institute on Aging (K24AG028443, K02AG020113, 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
- older adults, multimorbidity, clinical decision-making, patient values, adverse drug reactions, polypharmacy, treatment prioritization, patient perspectives, treatment discontinuation
- MeSH terms
- Aged, Choice Behavior, Decision Making, Drug Therapy, Female, Humans, Male, Comorbidity, Treatment Refusal, Treatment Outcome, Patient Satisfaction, Focus Groups, Drug-Related Side Effects and Adverse Reactions
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