Abstract
BACKGROUND: Medication decision making is complex, particularly for older patients with multiple conditions for whom benefits may be uncertain and health priorities may be variable. While patient input would seem important in the face of this uncertainty and variability, little is known about older patients’ views of involvement in medication decision making.
OBJECTIVE: To explore the views of older adults regarding participation in medication decision making.
DESIGN: Qualitative study.
PARTICIPANTS: Fifty-one persons at least 65 years old who consumed at least one medication were recruited from 3 senior centers and 4 physicians’ offices.
APPROACH: One-on-one interviews were conducted to uncover participants’ perceptions of medication-related decision making through semistructured, open-ended questions. Themes were compared according to the constant comparative method of analysis.
RESULTS: The predominant theme that emerged was the variability in perceptions concerning whether it was possible or desirable for patients to participate in prescribing decisions. For some participants, involvement was limited to sharing information. Physician and system factors that were felt to facilitate or impede patient participation included communication skills, the expanding number of medications available, multiple physicians prescribing for the same patient, and a focus on treating numbers. Perceived lack of knowledge, low self-efficacy, and fear were the patient factors mentioned. Both the presence and absence of trust in the prescribing physician were seen as alternatively impeding and enhancing patient participation. Only 1 participant explicitly mentioned patient preference, a cornerstone of shared decision making.
CONCLUSIONS: While evolution to greater patient involvement in medication decision making may be possible, and desirable to some older patients, findings suggest that the transition will be challenging.
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References
Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States. The slone survey. JAMA. 2002;287:337–44.
Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivela SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002;55:809–17.
Balkrishanan R. Predictors of medication adherence in the elderly [Review]. Clin Ther. 1998;20:764–7.
Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64.
Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107–16.
Tinetti ME, Bogardus ST, Agostini JV. Potential pitfalls in disease guidelines for patients with multiple conditions. N Engl J Med. 2004;351:2870–4.
Lewis DK, Robinson J, Wilkinson E. Factors involved in deciding to start preventive treatment: qualitative study of clinicians’ and lay people’s attitudes. BMJ. 2003;327:841–6.
Townsend A, Hunt K, Wyke S. Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use. BMJ. 2003;327:837–41.
Britten N, Stevenson FA, Barry CA, Barber N, Bradley CP. Misunderstandings in prescribing decisions in general practice: qualitative study. BMJ. 2000;320:484–8.
Berry DC, Michas IC, Gillie T, Forster M. What do patients want to know about their medicines and what do doctors want to tell them? A comparative study. Psychol Health. 1997;12:467–80.
Dickinson D, Raynor DK. What information do patients need about medicines? Ask the patients—they may want to know more than you think. BMJ. 2003;327:861–4.
Wyn G, Edwards A, Britten N. What information do patients need about medications? Doing prescribing: how doctors can be more effective. BMJ. 2003;327:864–7.
Tsevat J, Dawson NV, Wu AW, et al. Health values of hospitalized patients 80 years or older. JAMA. 1998;279:371–5.
Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346:1061–6.
Epstein RM, Alper BS, Quill TE. Communicating evidence for participatory decision making. JAMA. 2004;291:2359–66.
Schneider JK, Mion LC, Frengley JD. Adverse drug reactions in an elderly outpatient population. Am J Hosp Pharm. 1992;49:90–6.
Chaudhry SI, Krumholz HM, Foody JM. Systolic hypertension in older persons. JAMA. 2004;292:1074–80.
Dahlof B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in old patients with hypertension (STOP-Hypertension). Lancet. 1991;338:1281–5.
Mulrow CD, Cornell JA, Herrera CR, et al. Hypertension in the elderly. Implications and generalizability of randomized trials. JAMA. 1994;272:1932–8.
Systolic Hypertension in the Elderly Program Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA. 1991;265:3255–64.
Gueyffier F, Bulpitt C, Boissel J-P, et al. Antihypertensive drugs in very old people: a subgroup meta-analysis of randomized controlled trials. Lancet. 1999;353:793–6.
Gross CP, Mallory R, Heiat A, et al. Reporting the recruitment process in clinical trials: who are these patients and how did they get there? Ann Intern Med. 2002;137:10–6.
Whitney SN, McGuire AL, McCullough LB. Typology of shared decision making, informed consent, and simple consent. Ann Intern Med. 2003;140:54–9.
Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44:681–92.
Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49:651–61.
Arora NK, McHorney CA. Patient preferences for medical decision making: who really wants to participate? Med Care. 2000;38:335–41.
Flood AB, Wennberg JE, Nease RF Jr., Fowler FJ Jr., Ding J, Hynes LM. The importance of patient preference in the decision to screen for prostate cancer. Prostate Patient Outcomes Research Team. J Gen Intern Med. 1996;11:342–9.
Beaver K, Luker KA, Owens RG, Leinster SJ, Degner LF, Sloan JA. Treatment decision-making in women newly diagnosed with breast cancer. Cancer Nursing. 1996;19:8–19.
Degner LF, Sloan JA. Decision making during serious illness: what role do patients really want to play? J Clin Epidemiol. 1992;45:941–50.
Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision making? Arch Intern Med. 1996;156:1414–20.
Levinson W, Kao A, Kuby A, Thisted RA. Not all patients want to paticipate in decision making. A national study of public preferences. J Gen Intern Med. 2005;20:531–5.
Roccaforte WH, Burke WJ, Bayer BL, Wengel SP. Validation of a telephone version of the mini-mental state examination. J Am Geriatr Soc. 1992;40:697–702.
Cornoni-Huntley J, Brock DB, Ostfeld AM. Established Populations for the Epidemiologic Studies of the Elderly: Resource Data Book. US Department of Health and Human Services Publication NIH-86-2443. Washington, DC: National Institute on Aging; 1986.
Glaser PG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Hawthorne, NY: Aldine Publishing Co.; 1967.
Strauss A, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd edn. Thousand Oaks, CA: Sage Publications; 1998.
Crabtree B, Miller W, eds. Clinical Research a Multimethod Typology and Roadmap. Doing Qualitative Research. 2nd edn. Thousand Oaks, CA: Sage Publications; 1999.
Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992;267:2221–6.
Torke AM, Corbie-Smith GM, Branch WT. African American patients’ perspectives on medical decision making. Arch Intern Med. 2004;164:525–30.
Elywn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Prac. 1999;49:477–82.
Institute of Medicine. Crossing the quality chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
National Committee for Quality Assurance. The state of health care Quality: 2003. Washington, DC: National Committee for Quality Assurance; 2003.
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The authors have no conflicts of interest to report.
Funding source: This work was supported in part by a grant (P30AG10,469) to Yale University from the National Institute on Aging. Dr. Agostini is the recipient of a Veterans Affairs Health Services Career Development Award and a Merck/American Federation for Aging Research Junior Investigator Award in Geriatric Clinical Pharmacology. Dr. Fried is the recipient of National Institute on Aging Mid-Level Career Development Award.
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Belcher, V.N., Fried, T.R., Agostini, J.V. et al. Views of older adults on patient participation in medication-related decision making. J Gen Intern Med 21, 298–303 (2006). https://doi.org/10.1111/j.1525-1497.2006.00329.x
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DOI: https://doi.org/10.1111/j.1525-1497.2006.00329.x