Value Assessment in Healthcare Decision-Making of Ethnically and Cognitively Diverse Older Adults

Abstract Objective Little is known regarding the values that patients with mild cognitive impairment (MCI) incorporate into healthcare decision-making or how culture may affect such values. Even if values overlap across cultures, cultural groups may emphasize the importance of specific values differently since values emanate, at least in part, from cultural and life-long learning. The aim of this study was to explore and compare values that older adults of different ethnicities and cognitive statuses incorporate in their medical decisions. Participants and Method Four focus groups were established by identifying older adults as, a) Hispanic or non-Hispanic, and with b) normal cognition or MCI. Participants were recruited from the 1Florida Alzheimer’s Disease Research Center. Focus groups were audio-recorded and transcribed using a professional transcription service. Results There were a total of 23 participants (Age: M = 70.9, SD = 6.4). MCI groups had briefer discussions (Time M = 44 minutes) than the normal cognition groups (Time M = 62 minutes). Qualitative analysis of discussions was used to explore the values identified across the focus groups. The MCI groups valued spirituality, doctor recommendations, and family involvement when facing medical decisions. Normal cognition groups valued the necessity of proactive involvement as healthcare consumers and the relationship between the quality of patient-clinician interaction and their health care related decisions. Cultural themes involving perceptions of gender and generational differences emerged from the Hispanic normal cognition group. Conclusions This study identified many determinants influencing the medical decision-making process of diverse older adults: including past experiences, family involvement, healthcare barriers, and cultural background. These results have the potential to impact patient-clinician discussions, decisions made by surrogates, and the development of decision aids with a broader range of relevant patient values.

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Faculty Opinions recommendation of Older Adults' Recognition of Trade-Offs in Healthcare Decision-Making.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725639466.793512980 ◽

2016 ◽

Author(s):

Nanette Wenger

Keyword(s):

Older Adults ◽

Decision Making ◽

Healthcare Decision ◽

Trade Offs ◽

Healthcare Decision Making

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307 - Exploratory Study on Healthcare Decision-Making Capacity Assessment

International Psychogeriatrics ◽

10.1017/s1041610220002070 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 65-65

Author(s):

Ana Saraiva Amaral ◽

Rosa Marina Afonso ◽

Mário R. Simões ◽

Sandra Freitas

Keyword(s):

Decision Making ◽

Content Analysis ◽

Focus Groups ◽

Exploratory Study ◽

Assessment Instrument ◽

Funding Agency ◽

Capacity Assessment ◽

Healthcare Decision ◽

Healthcare Decision Making ◽

Decision Making Capacity

Mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) prevalence is expected to continue to increase, due to the population ageing. MCI and AD may impact patients’ decision-making capacities, which should be assessed through the disease course. These medical conditions can affect the various areas of decision-making capacity in different ways. Decision-making capacity in healthcare is particularly relevant among this population. Elders often suffer from multimorbidity and are frequently asked to make healthcare decisions, which can vary from consenting a routine diagnostic procedure to decide receiving highly risk treatments.To assess this capacity in elders with MCI or AD, we developed the Healthcare Decision-Making Capacity Assessment Instrument (IACTD-CS - Instrumento de Avaliação da Capacidade de Tomada de Decisão em Cuidados de Saúde). This project is funded by Portuguese national funding agency for science, research and technology, FCT (SFRH/BD/139344/2018). IACTD-CS was developed based on Appelbaum and Grisso four abilities model, literature review and review of international assessment instruments. After IACTD-CS first version development, an exploratory study with focus groups was conducted. This study included focus groups with healthcare professionals and nursing homes’ professionals.The focus groups main goals were: 1) understand the participants perception regarding healthcare decision-making capacity, 2) distinguish relevant aspects of decision-making, 3) discuss the abilities and items included in IACTD-CS and 4) identify new aspects or items to be added to IACTD-CS. A content analysis of the focus groups results, with resource to MAXQDA, was conducted afterwards. This exploratory study allowed to identify professionals’ perceptions on healthcare decision-making and its results were a significant contribute to IACTD-CS development. The proposed communication aims to describe the methodology used and present the results of content analysis.

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Literacy Mediates Racial Differences in Financial and Healthcare Decision Making in Older Adults

Journal of the American Geriatrics Society ◽

10.1111/jgs.16381 ◽

2020 ◽

Vol 68 (6) ◽

pp. 1279-1285 ◽

Cited By ~ 2

Author(s):

S. Duke Han ◽

Lisa L. Barnes ◽

Sue Leurgans ◽

Lei Yu ◽

David A. Bennett ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Racial Differences ◽

Healthcare Decision ◽

Healthcare Decision Making

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Medicare Plan Decisions: What Strategy Do Older Adults Use for e-Healthcare Decision-Making and What Intelligent Assistance Do They Need?

HCI International 2021 - Posters - Communications in Computer and Information Science ◽

10.1007/978-3-030-78635-9_41 ◽

2021 ◽

pp. 309-317

Author(s):

Kassandra Ross ◽

Wi-Suk Kwon ◽

Salisa Westrick ◽

Mohammad Shahidul Kader ◽

Yi Zhao ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Healthcare Decision ◽

Healthcare Decision Making ◽

Intelligent Assistance

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KNOWLEDGE AND BELIEFS ABOUT HEALTHCARE DECISION MAKING: ARE OLDER ADULTS’ ATTITUDES CHANGING?

The Gerontologist ◽

10.1093/geront/gnw162.1618 ◽

2016 ◽

Vol 56 (Suppl_3) ◽

pp. 404-404

Keyword(s):

Older Adults ◽

Decision Making ◽

Healthcare Decision ◽

Knowledge And Beliefs ◽

Healthcare Decision Making

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The Gray Zone: Adolescent and Young Adult Decision Support Needs for Ulcerative Colitis

MDM Policy & Practice ◽

10.1177/2381468320940708 ◽

2020 ◽

Vol 5 (2) ◽

pp. 238146832094070

Author(s):

Andrea Meisman ◽

Nancy M. Daraiseh ◽

Phil Minar ◽

Marlee Saxe ◽

Ellen A. Lipstein

Keyword(s):

Ulcerative Colitis ◽

Decision Making ◽

Decision Support ◽

Focus Groups ◽

Medical Decision Making ◽

Medical Decision ◽

Support Needs ◽

Final Decision ◽

Care Providers ◽

Medical Decisions

Purpose. To understand the medical decision support needs specific to adolescents and young adults (AYAs) with ulcerative colitis (UC) and inform development of a decision support tool addressing AYAs’ preferences. Methods. We conducted focus groups with AYAs with UC and mentors from a pediatric inflammatory bowel disease clinic’s peer mentoring program. Focus groups were led by a single trained facilitator using a semistructured guide aimed at eliciting AYAs’ roles in medical decision making and perceived decision support needs. All focus groups were audio recorded, transcribed, and coded by the research team. Data were analyzed using content analysis and the immersion crystallization method. Results. The facilitator led six focus groups: one group with peer mentors aged 18 to 24 years, three groups with patients aged 14 to 17 years, and two groups with patients aged 18 to 24 years. Decision timing and those involved in decision making were identified as interacting components of treatment decision making. Treatment decisions by AYAs were further based on timing, location (inpatient v. outpatient), and family preference for making decisions during or outside of clinic. AYAs involved parents and health care providers in medical decisions, with older participants describing themselves as “final decision makers.” Knowledge and experience were facilitators identified to participating in medical decision making. Conclusions. AYAs with UC experience changes to their roles in medical decisions over time. The support needs identified will inform the development of strategies, such as decision support tools, to help AYAs with chronic conditions develop and use skills needed for participating in medical decision making.

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