Older Adults' Recognition of Trade-Offs in Healthcare Decision-Making

Abstract

Objectives: To examine older persons' understanding of healthcare decision-making involving trade-offs.

Design: Cross-sectional survey.

Setting: Primary care clinics.

Participants: Community-living persons aged 65 and older (N = 50).

Measurements: After being primed to think about trade-offs with a focus on chronic disease management, participants were asked to describe a decision they had made in the past involving a trade-off. If they could not, they were asked to describe a decision they might face in the future and were then given an example of a decision. They were also asked about communication with their primary care provider about their priorities when faced with a trade-off.

Results: Forty-four participants (88%) were able to describe a healthcare decision involving a trade-off; 25 provided a decision in the past, 17 provided a decision they might face in the future, and two provided a future decision after hearing an example. One participant described a nonmedical decision, and two participants described goals without providing a trade-off. Of the healthcare decisions, 26 involved surgery, seven were end-of life decisions, seven involved treatment of chronic disease, and four involved chemotherapy. When asked whether their providers should know their health outcome priorities, 44 (88%) replied yes, and 35 (70%) believed their providers knew their priorities, but only 18 (36%) said that they had had a specific conversation about priorities.

Conclusion: The majority of participants were able to recognize the trade-offs involved in healthcare decision-making and wanted their providers to know their priorities regarding the trade-offs. Despite being primed to think about the trade-offs involved in day-to-day treatment of chronic disease, participants most frequently described episodic, high-stakes decisions including surgery and end-of-life care.

Keywords: chronic disease; decision-making; trade-offs.