Discussions about evidence and preferences in real-life general practice consultations with older patients.

Abstract

To explore how decisions are made in real-life general practice consultations with older patients (65+ years), and examine how general practitioners (GPs) communicate risk and benefit information and evidence, and integrate patient preferences. Secondary analysis of 20 video-recorded consultations with older patients in Australian primary healthcare settings. Consultations were analysed qualitatively using the Framework method and quantitatively using the Observer OPTION⁵ scale and the Assessing Communication about Evidence and Patient Preferences (ACEPP) tool. Overall, Observer OPTION⁵ and ACEPP scores were low, with mean total scores of 11.3 (out of 100) and 10.4 (out of 40) respectively. Together with qualitative findings, these results suggest that shared decision-making did not occur, and that healthcare options (including anticipated benefits and risks), evidence and patient preferences were rarely discussed in our sample of consultations with older people. GPs often unilaterally made treatment decisions (usually pharmacotherapy) while patients reverted to a passive decision-making role. We observed a lack of shared decision-making in our primary care study, with little engagement of older patients in decisions about their health. Training and support tools may be needed to enhance the capacity and self-efficacy of providers and older patients to share healthcare decisions.