Health Care Decision Making in Older Adults

描述(由申请人提供)：共享决策(SDM)，被定义为患者在卫生保健访问期间的积极参与，在文献和医学院课程中被广泛宣传为卫生保健决策的理想模式。有证据表明，SDM可以改善健康状况，但研究表明，增加SDM的尝试导致了一些患者更大的焦虑和不满。SDM的效果可能取决于患者愿意参与的程度。尤其是年龄较大的患者，不太可能想要参与重要的医疗决策。为了促进对老年患者的最佳以患者为中心的护理，了解是什么驱动了他们参与医疗访问的偏好是至关重要的。这个项目的总体目标是确定个人特征和过去的决策经验如何影响老年患者参与保健访问的偏好和与保健决策相关的主动行为。具体而言，该项目将：(1)根据参与偏好将老年人分为不同类型；(2)将这些偏好类型与个人特征(即作出决定的能力和长期的心理特征)、与以前的决策经验(保健和非保健相关)、以及与特定保健提供者以前的经验联系起来；(3)将与主动决策有关的行为，包括在互联网上寻求健康信息和完成预先指示(例如，生前遗嘱)，与个人特征和以前的经验联系起来。 我们将在威斯康星州纵向研究(WLS)的基础上再接再厉，该研究长达47年，跟踪了10,000多名1957年从威斯康星州高中毕业的男性和女性。受访者目前为-65岁，完成了广泛的电话和邮件调查，随着时间的推移，样本保留率很高。本轮调查包括有关卫生保健决策偏好和行为的项目。将使用聚类分析来表征偏好类型，并将使用多变量Logistic回归来将偏好类型和行为与个人特征和经历联系起来。还将检查AHRQ确定的一些优先人群的偏好和行为，包括低收入、健康状况不佳或患有慢性病的人、生活在农村地区的人和妇女。 这项拟议的研究将为临床医生、政策制定者和研究人员提供有价值的信息，促进以患者为中心的最佳护理。

DESCRIPTION (provided by the applicant): Shared decision-making (SDM), defined as active patient participation during health care visits, is widely promoted in the literature and medical school curricula as an ideal model for health care decision-making. There is evidence that SDM improves health outcomes, but studies show that attempts to increase SDM have resulted in greater anxiety and dissatisfaction for some patients. The effects of SDM are likely dependent on how much patients want to participate. Older patients, in particular, are less likely to want to participate in making important medical decisions. In order to promote optimal patient-centered care for older patients, it is essential that what drives their preferences for participation in health care visits be understood. The overall goal of this project is to determine how personal characteristics and past experiences with decision-making influence both preferences for participation in health care visits and proactive behaviors related to health care decisions for older patients. Specifically, this project will: (1) categorize older adults into types based on preferences for participation; (2) relate these preference types to personal characteristics (i.e., capacity to make decisions and long-standing psychological traits), to previous experiences with decision making (health care and non-health care related), and to previous experiences with a specific health care provider; and (3) relate proactive decision-related behaviors, including health information seeking on the Internet and completion of advance directives (e.g., living wills), to personal characteristics and previous experiences. We will build on the Wisconsin Longitudinal Study (WLS) which, for 47 years, has followed over 10,000 men and women who graduated from Wisconsin high schools in 1957. Respondents are currently 64-65 years old and have completed extensive telephone and mail surveys with high sample retention over time. Included in the current survey round are items on health care decision-making preferences and behaviors. Cluster analysis will be used to characterize preference types, and multivariate logistic regression will be used to relate preference types and behaviors to personal characteristics and experiences. Preferences and behaviors will also be examined in a number of AHRQ-defined priority populations, including persons with low income, poor health, or chronic illness, persons living in rural areas, and women. The proposed research will provide valuable information for promoting optimal patient-centered care to clinicians, policymakers, and researchers.