Introduction

Older man with doctorSometimes treating patients is not as clear-cut as we might wish. Maybe they have multiple conditions where treatment options interfere with each other, or clinicians disagree, or it just isn’t evident what is best to do. Maybe patients are less concerned about what might happen to them in the future and more focused on how they will feel tomorrow and next week. This is where Patient Priorities Care (PPC) comes in.

Patient Priorities Care is a shift in clinical decision-making from, “you need XX for your disease,” to “knowing all your health conditions and what matters most to you in terms of your health goals and healthcare, I suggest we try...”. Many clinicians think they already do this, but ask yourself what YOU would do in the following common scenarios where the right answer is not so clear. We have heard from many clinicians that they struggle with providing the best possible care for patients like the following:

Ms. S is a 78-year-old woman with ischemic cardiomyopathy who is frequently admitted to the hospital in decompensated heart failure. She tells you that she hates being admitted but also confesses to intermittently avoiding taking some of her medications because the side effects prevent her from going out with her grandson.

Mr. R is a 72-year-old man with hypertension, hypercholesterolemia, atrial fibrillation, diabetes, benign prostatic hyperplasia, and chronic obstructive pulmonary disease who comes to see you after a recent admission. He brings in his discharge paperwork and states he is overwhelmed and cannot manage the long list of indicated medications prescribed to him on discharge.

Mrs. B is an 80-year-old woman who is on anticoagulation for atrial fibrillation. At her last visit, you had a long conversation about the anticoagulation and decided to hold it. However, she recently saw her cardiologist, who restarted her anticoagulation. She is coming back to see you because she is confused about whether or not she should be taking it and who she should be listening to.

Finally, Mr. V is a 74-year-old man with many medical conditions including diabetes, hypertension, and a stroke with residual left sided weakness who comes in feeling burdened by his healthcare but cannot quite put his finger on what is most burdensome to him. He frequently stops all medications and cancels his appointments when he is feeling particularly overwhelmed.

Patient Priorities Care interprets treatment options through the lens of what matters most to each patient. Knowing how to elicit what matters most to our patients and how to translate that into healthcare that makes sense could improve the life of these patients and decrease the complexity and frustration that often comes from trying to care for patients with multiple conditions.

Ultimately by outlining and specifying what is most important to our patients, we will only be prescribing those medications and instituting those procedures that will further the patient’s goals and priorities. That focus cannot help but decrease the care burden on the individual.

- Doctor X

It was better [my care], because he [doctor] understood what I was saying...  He was always involved, but now he's more involved in how I'm feeling, and how the medicine is making me feel.

- Patient Y

The following short video provides an engaging look at what Patient Priorities Care is all about.

If you have any questions about the Patient Priorities Care approach, you can visit the website at https://patientprioritiescare.org/

The Learning Modules

The following three modules provide an introduction to how you might improve the care of patients like those described in the previous scenarios by identifying patient priorities (the health outcomes they most desire given the healthcare they are able and willing to do or receive) and then aligning the patient’s healthcare with those specific priorities.

The modules introduce a patient and his wife, Mr. and Mrs. K, who have become burdened with Mr. K’s healthcare. They struggle to keep up with his appointments, testing, and medications. Mr. K and the patients in the above scenarios are examples of patients where the disease guideline approach may not be the best care. After completing these modules, you will be able to identify patients like Mr. K and help them realign their healthcare with their own health priorities.

ModuleHelping Your Patients Identify their Health PrioritiesIntroduction to Patient Priorities-Aligned Decision MakingCommon Challenges in Patient Priorities-Aligned Decision Making
Module ContentHow do you help patients identify their specific, actionable, and reliable health outcomes and healthcare preferences?How do you determine whether guideline-driven, disease-focused care is best for your patient? How do you change their care to better align with their priorities?What strategies are available to identify and overcome typical challenges faced during providing patient priorities care?
Who Should Take This Module

Any member of the healthcare team can be trained to help identify health priorities.
CME/MOC eligible
CE-eligible for nurses

Physicians
CME/MOC eligible

Others may review the module as interested.

Physicians
CME/MOC eligible

Others may review the module as interested.

Most clinicians do some of the decision-making portrayed in the modules some of the time. Patient Priorities Care provides systematic strategies for aligning care with patients’ priorities, thus getting patients and all their clinicians on the same page. These modules will provide you with the knowledge and skills to improve the healthcare of your patients — especially older adults with multiple chronic conditions where disease guideline-based medicine often does not apply and the best care is not always obvious.

The crux of why we care for patients is making sure that when we do things for them and to them, we're doing it with their needs and their current function as a paramount goal. If we're not asking that question on a regular basis, then we're not doing our job. And Patient Priorities Care gives us that particular tool in a very well-designed and regimented way to seek out the patients' needs and to implement changes in their care based on those needs.

- Doctor Z

And today, thanks to working with my healthcare team, I have more time to do things that I enjoy.  I have a care team that listens to me and has made changes in my care to help me do more of what matters most [to me].

- Patient W

Older woman with dog

This work is generously funded by the John A. Hartford Foundation, Robert Wood Johnson Foundation, and the Gordon and Betty Moore Foundation.