A new qualitative study identified common themes among clinicians treating older adults with multiple chronic conditions. Clinicians agreed that multiple chronic conditions complicate care, making it challenging to care for this population. To a lesser extent, clinicians also mentioned that a patient’s negative experience and lack of trust in the health care system is also a challenge.
Through virtual case-based coaching sessions, clinicians discussed how Patient Priorities Care addresses these challenges. Patient Priorities Care is an age-friendly approach to health care that focuses decision-making on what matters most: patients’ own health priorities.
“Case-based discussions allow health professionals and trainees to participate in active learning,” says Jennifer Ouellet, MD, assistant professor of medicine (geriatrics). “They get to apply the Patient Priorities Care tools to their own patient cases, leaving with a sense of empowerment to enact a change in clinical decision-making.”
Clinicians were trained on Patient Priorities Care and implemented it locally with the facilitation of a Patient Priorities Care practice champion. All participating clinicians were internal medicine-trained primary care physicians. As part of their training, clinicians were invited to present their own patient cases on a video conference call and receive coaching from Patient Priorities Care faculty. To allow for open exploration of themes, a specific interview guide was not used.
Three common subthemes emerged: Patient Priorities Care addresses complexity and uncertainty in decision-making; improves relationships among health care team members and patients; and enables efficient decision-making or saves time.
One discussant said Patient Priorities Care was “helpful to reduce the number of visits” and to “focus on what I should focus on with [the patient's] multisystem disease.”
Implementing Patient Priorities Care in practice does not come without barriers, however. The most mentioned rationale was that quality metrics are designed around specific diseases and that more clinicians are not trained on this approach. Additionally, clinicians mentioned that an acute event or new diagnosis sidetrack theirfocus.
Despite the barriers, enablers in Patient Priorities Care implementation were mentioned more than twice as often. The most prevalent subtheme is that patients’ priorities inform clinical decision-making. One discussant said, “What is the thing that they’re trying to do, and how is it linked to something that’s really important to them?”
Other prevalent enablers are tools and resources and a clinician “aha” moment, or perspective shift to Patient Priorities Care. “I think that’s an attitudinal shift … for me to show that I’m acknowledging and bearing witness to my patient’s concern,” said one of the participants. “And I’m also contextualizing it with a medical problem and connecting the two.”
Read “A qualitative study of coaching patient priorities-aligned decision-making through virtual case-based discussions” in Journal of the American Geriatrics Society.
Patient Priorities Care (PPC) offers evidence-based tools and resources to help patients, care partners, and clinicians focus decision-making and healthcare on what Matters Most: patients’ own health priorities. Patient Priorities Care is suitable for any patient, but especially older adults managing multiple chronic conditions. PPC is a Yale research project from the Department of Internal Medicine’s Section of Geriatrics, led by co-creator Mary Tinetti, MD, who is the principal investigator on the grant. PPC is now focusing efforts on spreading awareness and training clinicians across the U.S.