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Cover of Values of Older Adults Related to Primary and Secondary Prevention

Values of Older Adults Related to Primary and Secondary Prevention

Evidence Syntheses, No. 84

Investigators: , PhD, MBA, , PhD, RN, , , , PhD, , PhD, , DSW, and , MD.

Minnesota Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 11-05154-EF-1

Structured Abstract

Objectives:

To inform the U.S. Preventive Services Task Force deliberations on recommendations around preventive care for older persons by assessing how older adults value the potential benefits of clinical preventive services, what attitudes older adults have about potential harms of clinical preventive services, how older adults understand the balance of risks and benefits of clinical preventive services, and how clinicians should engage in shared decisionmaking related to clinical preventive services for older adults.

Data Sources:

We searched Ovid MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsychINFO, the Cochrane Database of Systematic Reviews, and EconLit databases, and consulted with experts in the field.

Review Methods:

We selected English-language articles on preferences, lay understanding, choice behavior, patient/provider relationships, and shared decisionmaking regarding primary and secondary prevention that focused on a population aged 65 years and older.

Results:

Very little literature exists addressing older people’s perceived benefits and harms of preventive services, their decisional balance, and shared decisionmaking for preventive services. The literature identified in this review yielded a broad range of perceived benefits and harms for primary and secondary prevention, differing by those who had or had not received preventive services, the disease addressed by the intervention, and age group (e.g., the young old versus the old old). The values older adults placed on clinical preventive services were similarly variable and resistant to generalization. The literature on shared decisionmaking for preventive services for older adults demonstrated favorable response to such interventions and no indication whether older adults as a group have a different level of interest compared to other age groups. Not every older adult wants to engage in shared decisionmaking in the same way; clinicians need to determine how much an individual patient wants to be involved in his or her own screening choices. The studies largely used qualitative or descriptive analysis methods with small purposive samples.

Conclusions:

People’s values for preventive services and their attendant benefits, risks, and harms reflect all sorts of inputs, including prior experiences, habits, strengths, and other idiosyncrasies. This individual variation makes generalizations dangerous. Patient-centered care may not always require shared decisionmaking; clinicians need to better understand how patients value their own role in clinical decisionmaking. Future research is needed in the field covered by this review, including exploration of differences between age groups within the older adult population, tools to measure values and preferences, and identification of what helps and hinders older adults’ ability to engage in shared decisionmaking.

Evidence-based Practice Center Director: Robert L Kane, MD; Task Order Officer: Therese Miller, DrPH; Medical Officer: Tracy Wolff, MD, MPH.

Acknowledgments: The authors thank Christa Prodzinski, Karen Rashke, Nancy Russell, Molly Jeffery, and Deborah Kniebel for their assistance with abstracting, managing the endnote library, and editorial work. The authors thank Marilyn Eells for her editing assistance.

Peer Reviewers: The authors also thank the following peer reviewers for their comments and suggestions: Cynthia Boyd, MD, MPH, Johns Hopkins Medicine, Baltimore, MD; Dennis McCullough, MD, Dartmouth Medical School, Hanover, NH; Floyd J. Fowler, Jr., PhD, University of Massachusetts, Boston, MA

Technical Expert Panel: The authors also thank the following Technical Expert Panel members for their time and expert guidance: Howard Leventhal, PhD, Rutgers, The State University of New Jersey, New Brunswick, NJ; Judith Hibbard, DrPH, University of Oregon, Eugene, OR; Erica Breslau, PhD, National Cancer Institute, Bethesda, MD; Susan Curry, PhD, University of Iowa, Iowa City, IA; Michael LeFevre, MD, University of Missouri,Columbia, MO; Rosanne M. Leipzig, MD, PhD, Mount Sinai School of Medicine, New York, NY

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract Number: HHSA-290-2007-10064-1 Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, Minnesota

Suggested citation:

Butler M, Talley KM, Burns R, Ripley A, Rothman A, Johnson P, Kane RA, Kane RL. Values of Older Adults Related to Primary and Secondary Prevention. Evidence Synthesis No. 84. AHRQ Publication No. 11-05154-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; March 2011.

This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2007-10064-1). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliation or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; http://www‚Äč.ahrq.gov

Bookshelf ID: NBK53769PMID: 21542546

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