Development of a Clinically Feasible Process for Identifying Individual Health Priorities.

ObjectivesTo develop a values-based, clinically feasible process to help older adults identify health priorities that can guide clinical decision-making. DesignProspective development and feasibility study. SettingPrimary care practice in Connecticut. ParticipantsOlder adults with 3 or more conditions or taking 10 or more medications (N=64). InterventionThe development team of patients, caregivers, and clinicians used a user-centered design frameworkideate prototype test redesignto develop and refine the value-based patient priorities care process and medical record template with trained clinician facilitators. MeasurementsWe used descriptive statistics of quantitative measures (percentage accepted invitation and completed template, duration of process) and qualitative analysis of barriers and enablers (challenges and solutions identified, facilitator perceptions). ResultsWe developed and refined a process for identifying patient health priorities that was typically completed in 35 to 45 minutes over 2 sessions; 64 patients completed the process. Qualitative analyses were used to elucidate the characteristics and training needed for the patient priorities facilitators, as well as perceived benefits and challenges of the process. Refinements based on our experience and feedback include streamlining the process for greater feasibility, balancing fidelity to the process while customizing to individuals, encouraging patients to share their priorities with their clinicians, and simplifying the template transmitted to clinicians. ConclusionTrained facilitators conducted this process in a busy primary care practice, suggesting that patient priorities identification is feasible and acceptable, although testing in additional settings is necessary. We hope to show that clinicians can align care with patients' health priorities.