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. 2011 May;83(2):278-82.
doi: 10.1016/j.pec.2010.04.032. Epub 2010 May 31.

Health outcome prioritization to elicit preferences of older persons with multiple health conditions

Terri R Fried  1 , Mary Tinetti, Joe Agostini, Lynne Iannone, Virginia Towle
Affiliations

Health outcome prioritization to elicit preferences of older persons with multiple health conditions

Terri R Fried et al. Patient Educ Couns. 2011 May.

Abstract

Objective: To develop and test a simple tool to elicit the preferences of older persons based on prioritization of universal health outcomes.

Methods: Persons age ≥ 65 participating in a larger study were asked to rank 4 outcomes on a visual analogue scale: (1) maintaining independence, (2) staying alive, (3) reducing/eliminating pain, (4) reducing/eliminating other symptoms.

Results: Interviewers rated 73% of the 81 participants as having good to excellent understanding, and cognitive interviews demonstrated the tool captured how participants thought about trade-offs. Test-retest reliability was fair to poor for ranking most of the outcomes as either most or least important (kappa .28-1.0). Patient characteristics associated with ranking "keeping you alive" as most important have been shown to be associated with a preference for life-sustaining treatment, a related construct. There was substantial variability in the outcome ranked as most important.

Conclusions: The task of ranking 4 universal health outcomes was well understood, captured what was important when considering trade-offs, and demonstrated content validity. However, test-retest reliability was fair to poor.

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Figures

Figure 1
Figure 1
Screen Shot of Prioritization Tool
See this image and copyright information in PMC

References

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    1. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294:716–724. - PubMed
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    1. Fried TR, McGraw S, Agostini JV, Tinetti ME. Views of older persons with multiple morbidities on competing outcomes and clinical decision-making. J Am Geriatr Soc. 2008;56:1839–1844. - PMC - PubMed

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