Complex health care decisions with older patients in general practice: Patient-centeredness and prioritization in consultations following a geriatric assessment

摘要

Objective: To examine to what extent general practitioners in consultations after a geriatric assessment set shared health priorities with older patients experiencing multimorbidity and to what extent this was facilitated through patient-centered behavior. Methods: Observation of consultations embedded in a cluster randomized controlled trial,. 11German Trial Register DKS 00000792. in which 317 patients from 41 general practices received the STEP assessment followed by a care planning consultation with their GPs. GPs in the intervention group used a structured procedure for setting health (care) priorities in contrast to control GPs. A sample of 43 consultations (24 intervention; 19 control) were recorded, transcribed and analyzed with regard to priority setting and patient-centeredness. Results: Patient-centeredness was only moderately apparent in consultations dealing with complex care plans for older patients with multimorbidity. The shared determination of health priorities seemed unusual for both doctors and patients and was rarely practiced, albeit more frequently in intervention consultations. Conclusion: Setting health care priorities with patients experiencing multimorbidity is ethically desirable and medically appropriate. Yet a short structured guide for doctors cannot easily achieve this. Practice implications: More research is needed in regard to handling complex health needs of older patients. It requires a professional approach and training in patient-centered holistic care planning.