Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study
Linnaea Schuttner,1,2 Jenney R Lee,1,3 Stacey Hockett Sherlock,4,5 James D Ralston,6,7 Ann-Marie Rosland,8,9 Karin Nelson,1,2 Carol Simons,1 George G Sayre1,7 1Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA; 2Department of Medicine, University of Wash...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2022-11-01
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| Series: | Risk Management and Healthcare Policy |
| Subjects: | |
| Online Access: | https://www.dovepress.com/primary-care-physician-perspectives-on-the-influence-of-patient-values-peer-reviewed-fulltext-article-RMHP |
| _version_ | 1797983745924399104 |
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| author | Schuttner L Lee JR Hockett Sherlock S Ralston JD Rosland AM Nelson K Simons C Sayre GG |
| author_facet | Schuttner L Lee JR Hockett Sherlock S Ralston JD Rosland AM Nelson K Simons C Sayre GG |
| author_sort | Schuttner L |
| collection | DOAJ |
| description | Linnaea Schuttner,1,2 Jenney R Lee,1,3 Stacey Hockett Sherlock,4,5 James D Ralston,6,7 Ann-Marie Rosland,8,9 Karin Nelson,1,2 Carol Simons,1 George G Sayre1,7 1Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA; 2Department of Medicine, University of Washington, Seattle, WA, USA; 3Department of Urology, University of Washington, Seattle, WA, USA; 4Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System, Iowa City, IA, USA; 5Carver College of Medicine, University of Iowa, Iowa City, IA, USA; 6Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; 7Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA; 8VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; 9Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USACorrespondence: Linnaea Schuttner, Email linnaea.schuttner@va.govIntroduction: The prevalence of patients with multimorbidity (ie, multiple chronic conditions) is increasing. Clinical decision-making guided by patients’ values, health priorities and goals, and treatment preferences is particularly important in the context of interacting diseases and psychosocial needs. Physicians face challenges incorporating patient perspectives into care plans. We examined primary care physician (PCP) views on the influence of patients’ values, health priorities and goals, and preferences on clinical decisions for patients with multimorbidity and increased psychosocial complexity.Methods: We conducted semi-structured telephone interviews with 23 PCPs within patient-centered medical home teams in a nationally integrated health system in the United States between May and July 2020. Data were analyzed via thematic analysis with deductive and inductive coding.Results: Three major themes emerged: 1. Patient personal values were rarely explicitly discussed in routine clinical encounters but informed more commonly discussed concepts of patient priorities, goals, and preferences; 2. Patient values, health priorities and goals, and preferences were sources of divergent views about care plans between healthcare teams, patients, and families; 3. Physicians used explicit strategies to communicate and negotiate about patient values, health priorities and goals, and preferences when developing care plans, including trust-building; devoting extra effort to individualizing care; connecting patient values to healthcare recommendations; deliberate elicitation and acknowledgement of patient concerns; providing “space” for patient perspectives; incorporating family into care planning; pairing physician to patient priorities; and collaborative teamwork.Conclusion: Primary care physicians perceive patient values, health priorities and goals, and preferences as influential during clinical decision-making for complex patients with multimorbidity. Participants used concrete strategies to negotiate alignment of these aspects when physician-patient divergence occurred. While rarely discussed directly in clinical encounters, personal values affected patient health priorities, goals, and preferences during care planning, suggesting a clinical role for more deliberate elicitation and discussion of patient values for this population.Keywords: multimorbidity, clinical decision-making, patient-centered care, primary care, qualitative study, patient values and preferences |
| first_indexed | 2024-04-11T06:52:15Z |
| format | Article |
| id | doaj.art-4286d6432ee146b59b8e1df848ba6f7e |
| institution | Directory Open Access Journal |
| issn | 1179-1594 |
| language | English |
| last_indexed | 2024-04-11T06:52:15Z |
| publishDate | 2022-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Risk Management and Healthcare Policy |
| spelling | doaj.art-4286d6432ee146b59b8e1df848ba6f7e2022-12-22T04:39:09ZengDove Medical PressRisk Management and Healthcare Policy1179-15942022-11-01Volume 152135214679711Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative StudySchuttner LLee JRHockett Sherlock SRalston JDRosland AMNelson KSimons CSayre GGLinnaea Schuttner,1,2 Jenney R Lee,1,3 Stacey Hockett Sherlock,4,5 James D Ralston,6,7 Ann-Marie Rosland,8,9 Karin Nelson,1,2 Carol Simons,1 George G Sayre1,7 1Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA; 2Department of Medicine, University of Washington, Seattle, WA, USA; 3Department of Urology, University of Washington, Seattle, WA, USA; 4Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System, Iowa City, IA, USA; 5Carver College of Medicine, University of Iowa, Iowa City, IA, USA; 6Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; 7Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA; 8VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; 9Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USACorrespondence: Linnaea Schuttner, Email linnaea.schuttner@va.govIntroduction: The prevalence of patients with multimorbidity (ie, multiple chronic conditions) is increasing. Clinical decision-making guided by patients’ values, health priorities and goals, and treatment preferences is particularly important in the context of interacting diseases and psychosocial needs. Physicians face challenges incorporating patient perspectives into care plans. We examined primary care physician (PCP) views on the influence of patients’ values, health priorities and goals, and preferences on clinical decisions for patients with multimorbidity and increased psychosocial complexity.Methods: We conducted semi-structured telephone interviews with 23 PCPs within patient-centered medical home teams in a nationally integrated health system in the United States between May and July 2020. Data were analyzed via thematic analysis with deductive and inductive coding.Results: Three major themes emerged: 1. Patient personal values were rarely explicitly discussed in routine clinical encounters but informed more commonly discussed concepts of patient priorities, goals, and preferences; 2. Patient values, health priorities and goals, and preferences were sources of divergent views about care plans between healthcare teams, patients, and families; 3. Physicians used explicit strategies to communicate and negotiate about patient values, health priorities and goals, and preferences when developing care plans, including trust-building; devoting extra effort to individualizing care; connecting patient values to healthcare recommendations; deliberate elicitation and acknowledgement of patient concerns; providing “space” for patient perspectives; incorporating family into care planning; pairing physician to patient priorities; and collaborative teamwork.Conclusion: Primary care physicians perceive patient values, health priorities and goals, and preferences as influential during clinical decision-making for complex patients with multimorbidity. Participants used concrete strategies to negotiate alignment of these aspects when physician-patient divergence occurred. While rarely discussed directly in clinical encounters, personal values affected patient health priorities, goals, and preferences during care planning, suggesting a clinical role for more deliberate elicitation and discussion of patient values for this population.Keywords: multimorbidity, clinical decision-making, patient-centered care, primary care, qualitative study, patient values and preferenceshttps://www.dovepress.com/primary-care-physician-perspectives-on-the-influence-of-patient-values-peer-reviewed-fulltext-article-RMHPmultimorbidityclinical decision-makingpatient-centered careprimary carequalitative studypatient values and preferences |
| spellingShingle | Schuttner L Lee JR Hockett Sherlock S Ralston JD Rosland AM Nelson K Simons C Sayre GG Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study Risk Management and Healthcare Policy multimorbidity clinical decision-making patient-centered care primary care qualitative study patient values and preferences |
| title | Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study |
| title_full | Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study |
| title_fullStr | Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study |
| title_full_unstemmed | Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study |
| title_short | Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study |
| title_sort | primary care physician perspectives on the influence of patient values health priorities and preferences on clinical decision making for complex patients with multimorbidity a qualitative study |
| topic | multimorbidity clinical decision-making patient-centered care primary care qualitative study patient values and preferences |
| url | https://www.dovepress.com/primary-care-physician-perspectives-on-the-influence-of-patient-values-peer-reviewed-fulltext-article-RMHP |
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