Mary F Wyman1, Daniel Liebzeit2, Corrine I Voils3, Barbara J Bowers4, Elizabeth N Chapman5, Andrea Gilmore-Bykovskyi6, Korey A Kennelty7, Amy J H Kind8, Julia Loosen9, Nicole Rogus-Pulia10, Melissa Dattalo11. 1. Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Electronic address: mfwyman@wisc.edu. 2. Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA; School of Nursing, University of Wisconsin, Madison, WI, USA. Electronic address: daniel.liebzeit@wisc.edu. 3. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Research Service, W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA. Electronic address: voils@surgery.wisc.edu. 4. School of Nursing, University of Wisconsin, Madison, WI, USA. Electronic address: bjbowers@wisc.edu. 5. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA. Electronic address: EChapman@uwhealth.org. 6. School of Nursing, University of Wisconsin, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA. Electronic address: algilmore@wisc.edu. 7. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. Electronic address: korey-kennelty@uiowa.edu. 8. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Health Services and Care Research Program, Department of Medicine, University of Wisconsin, Madison, WI, USA. Electronic address: ajk@medicine.wisc.edu. 9. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Electronic address: jloosen@wisc.edu. 10. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA. Electronic address: npulia@wisc.edu. 11. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA. Electronic address: MDattalo@uwhealth.org.
Abstract
OBJECTIVE: Integration of patient-identified goals is a critical element of shared decision-making and patient-provider communication. There is limited information on the goals of patients with multiple medical conditions and high healthcare utilization. We aimed to identify and categorize the goals described by "high-need, high-cost" (HNHC) older patients and their caregivers. METHODS: Using conventional content analysis, we used data from interviews conducted with 17 HNHC older patients (mean age 72.5 years) and 4 caregivers. RESULTS: HNHC older patients and their caregivers used language such as "hopes, wishes, and wants" to describe their goals, which fell into eight categories: alleviating discomfort, having autonomy and control, decreasing treatment burden, maintaining physical functioning and engagement, leaving a legacy, extending life, having satisfying and effective relationships, and experiencing security. CONCLUSION: Our results contribute to knowledge of goals of HNHC patients and provides guidance for improving the patient-provider relationship and communication between HNHC older patients and their healthcare providers. PRACTICE IMPLICATIONS: Our findings can inform provider efforts to assess patient goals and engage high-need, high-cost older patients in shared decision-making. Further, this study contributes to an improved understanding of HNHC older patients to support continued development of effective care models for this population. Published by Elsevier B.V.
OBJECTIVE: Integration of patient-identified goals is a critical element of shared decision-making and patient-provider communication. There is limited information on the goals of patients with multiple medical conditions and high healthcare utilization. We aimed to identify and categorize the goals described by "high-need, high-cost" (HNHC) older patients and their caregivers. METHODS: Using conventional content analysis, we used data from interviews conducted with 17 HNHC older patients (mean age 72.5 years) and 4 caregivers. RESULTS: HNHC older patients and their caregivers used language such as "hopes, wishes, and wants" to describe their goals, which fell into eight categories: alleviating discomfort, having autonomy and control, decreasing treatment burden, maintaining physical functioning and engagement, leaving a legacy, extending life, having satisfying and effective relationships, and experiencing security. CONCLUSION: Our results contribute to knowledge of goals of HNHC patients and provides guidance for improving the patient-provider relationship and communication between HNHC older patients and their healthcare providers. PRACTICE IMPLICATIONS: Our findings can inform provider efforts to assess patient goals and engage high-need, high-cost older patients in shared decision-making. Further, this study contributes to an improved understanding of HNHC older patients to support continued development of effective care models for this population. Published by Elsevier B.V.
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