Assessing Patient Interest in Individualized Preventive Care Recommendations

Abstract

Background. Few Americans obtain all 41 guideline-recommended preventive services for nonpregnant adults. We assessed patient interest in prioritizing their preventive care needs. Methods. We conducted a mixed-methods study, with 4 focus groups (N = 28) at a single institution and a nationwide survey (N = 2,103). Participants were middle-aged and older adults with preventive care needs. We obtained reactions to written materials describing the magnitude of benefit from major preventive services, including both absolute and relative benefits. Recommendations were individualized for patient risk factors ("individualized preventive care recommendations"). Focus groups assessed patient interest, how patients would want to discuss individualized recommendations with their providers, and potential for individualized recommendations to influence patient decision making. Survey content was based on focus groups and analyzed with logistic regression. Results. Patients expressed strong interest in individualized recommendations. Among survey respondents, an adjusted 88.2% (95% confidence interval [CI] = 86.7% to 89.7%) found individualized recommendations very easy to understand, 77.2% (95% CI = 75.3% to 79.1%) considered them very useful, and 64.9% (95% CI = 62.8% to 67.0%) highly trustworthy (each ≥6/7 on Likert scale). Three quarters of participants wanted to receive their own individualized recommendations in upcoming primary care visits (adjusted proportion = 77.5%, 95% CI = 75.6% to 79.4%). Both focus group and survey participants supported shared decision making and reported that individualized recommendations would improve motivation to obtain preventive care. Half of survey respondents reported that they would be much more likely to visit their doctor if they knew individualized recommendations would be discussed, compared with 4.2% who would not be more likely to visit their doctor. Survey respondents already prioritized preventive services, stating they were most likely to choose quick/easy preventive services and least likely to choose expensive preventive services (adjusted proportions, 63.8% and 8.5%, respectively). Results were consistent in sensitivity analyses. Conclusions. Individualized preventive care recommendations are likely to be well received in primary care and might motivate patients to improve adherence to evidence-based care.

Keywords: Decision Making; Preventive Health Services; Preventive Medicine; Shared.

Figure 1

Examples of survey text to help respondents imagine personalized information. *Pronouns were individualized for each respondent’s self-reported sex.

Figure 2

Example visual aid for individualized preventive care recommendations. An example visual aid shown to focus group and survey participants. See Appendix 3 for alternatives. Pronouns were individualized for each respondent’s self-reported sex. “Get a Mammogram” was only shown to females. The height of the bars was proportionate to the estimated change in life expectancy associated with lifetime adherence to each preventive service, based on prior literature.

Figure 3

Patient prioritization of preventive care services. (A) Prioritization based on number of recommended preventive services. (B) Actions taken to prioritize preventive care services. The survey assessed whether and how respondents already prioritize among their preventive care options. Panel A stated, “It can be hard when your doctor asks you to make a lot of changes to improve your health. When answering the questions below, please think about how many changes you could make in your life in the next 4 weeks, while also maintaining your relationships with your family and friends, your work, and your hobbies. In your opinion: In the next 4 weeks, how likely would you be to do everything your doctor recommended if your doctor recommended [1, 2, 3, 5, or 8] preventive care services?” Panel B stated, “Imagine that you visit your doctor today, and he or she recommends too many preventive care services (more than you feel able to do). In your opinion, which of the following would you be likely to do in the next 4 weeks? Both panels utilized a 7-point Likert-type scale from “not at all likely” to “very likely”. Error bars denote 95% confidence intervals.