Health outcome prioritization to elicit preferences of older persons with multiple health conditions.
OBJECTIVE
To develop and test a simple tool to elicit the preferences of older persons based on prioritization of universal health outcomes.


METHODS
Persons age ≥ 65 participating in a larger study were asked to rank 4 outcomes on a visual analogue scale: (1) maintaining independence, (2) staying alive, (3) reducing/eliminating pain, (4) reducing/eliminating other symptoms.


RESULTS
Interviewers rated 73% of the 81 participants as having good to excellent understanding, and cognitive interviews demonstrated the tool captured how participants thought about trade-offs. Test-retest reliability was fair to poor for ranking most of the outcomes as either most or least important (kappa .28-1.0). Patient characteristics associated with ranking "keeping you alive" as most important have been shown to be associated with a preference for life-sustaining treatment, a related construct. There was substantial variability in the outcome ranked as most important.


CONCLUSIONS
The task of ranking 4 universal health outcomes was well understood, captured what was important when considering trade-offs, and demonstrated content validity. However, test-retest reliability was fair to poor.
Fried
Terri R
TR
Department of Medicine, Yale University School of Medicine, New Haven, CT, USA. terri.fried@yale.edu
Tinetti
Mary
M
Agostini
Joe
J
Iannone
Lynne
L
Towle
Virginia
V
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002908:Chronic Disease; D003657:Decision Making; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011594:Psychometrics; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States