Health Care Decision Making in Older Adults

描述（由申请方提供）：共同决策（SDM）定义为患者在医疗保健访视期间的积极参与，在文献和医学院课程中作为医疗保健决策的理想模型得到广泛推广。 有证据表明SDM可以改善健康状况，但研究表明，试图增加SDM会导致一些患者更大的焦虑和不满。 SDM的效果可能取决于患者想要参与的程度。 特别是老年患者，他们不太可能愿意参与重要的医疗决策。 为了促进老年患者以患者为中心的最佳护理，了解他们参与医疗保健访问的偏好是至关重要的。 本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医疗保健访问的偏好和与医疗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类;（2）将这些偏好类型与个人特征（即，做出决定的能力和长期存在的心理特征），与之前的决策经验（医疗保健和非医疗保健相关），以及与特定医疗保健提供者的先前经验相关;以及（3）将主动决策相关行为，包括在互联网上寻求健康信息和完成预先指令（例如，生前遗嘱），个人特征和以前的经验。 我们将以威斯康星州纵向研究（WLS）为基础，该研究47年来跟踪了1957年从威斯康星州高中毕业的1万多名男女。 受访者目前年龄在64-65岁之间，已经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。 包括在目前的调查轮是关于医疗保健决策的偏好和行为的项目。 聚类分析将用于描述偏好类型，多元逻辑回归将用于将偏好类型和行为与个人特征和经历联系起来。 还将对一些AHRQ确定的优先人群的偏好和行为进行审查，包括低收入、健康状况不佳或慢性病患者、生活在农村地区的人和妇女。 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，以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.