New elements for informed decision making: a qualitative study of older adults' views.

Abstract

OBJECTIVE: To explore older adults' views of existing informed decision making (IDM) elements and investigate the need for additional elements. METHODS: We recruited persons 65 and older to participate in six focus groups. Participants completed questionnaires about IDM preferences, and discussed videotapes of idealized patient-physician interactions in light of seven IDM elements: (1) discussion of the patient's role in decision making; (2) discussion of the clinical issue; (3) discussion of alternatives; (4) discussion of benefits/risks; (5) discussion of uncertainties; (6) assessment of patient understanding; and (7) exploration of patient preference. We used a modified grounded theory approach to assess agreement with existing IDM elements and identify new elements. RESULTS: In questionnaires, 97-100% of 59 participants rated each IDM element as "somewhat" or "very" important. Qualitative analysis supported existing elements and suggested two more: opportunity for input from trusted others, and discussion of decisions' impacts on patients' daily lives. Elements overlapped with global communication themes. CONCLUSION: Focus groups affirmed existing IDM elements and suggested two more with particular relevance for older patients. PRACTICE IMPLICATIONS: Incorporation of additional IDM elements into clinical practice can enhance informed participation of older adults in decision making.