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.

Content Provider	Europe PMC
Author	Schuttner, Linnaea Lee, Jenney R Hockett Sherlock, Stacey Ralston, James D Rosland, Ann-Marie Nelson, Karin Simons, Carol Sayre, George G
Copyright Year	2022
Abstract	IntroductionThe 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.MethodsWe 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.ResultsThree 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.ConclusionPrimary 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.
Page Count	12
Journal	Risk Management and Healthcare Policy
Volume Number	15
PubMed Central reference number	PMC9675988
PubMed reference number	36415219
e-ISSN	11791594
DOI	10.2147/RMHP.S380021
Language	English
Publisher	Dove
Publisher Date	2022-11-16
Access Restriction	Open
Rights License	This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). © 2022 Schuttner et al.
Subject Keyword	multimorbidity clinical decision-making patient-centered care primary care qualitative study patient values and preferences
Content Type	Text
Resource Type	Article
Subject	Health Policy Public Health, Environmental and Occupational Health