title: New elements for informed decision making: a qualitative study of older adults' views.
abstract: OBJECTIVE
  To explore older adults' views of existing informed decision making (IDM) elements and investigate the need for additional elements.
  
  
  METHODS
  We recruited persons 65 and older to participate in six focus groups. Participants completed questionnaires about IDM preferences, and discussed videotapes of idealized patient-physician interactions in light of seven IDM elements: (1) discussion of the patient's role in decision making; (2) discussion of the clinical issue; (3) discussion of alternatives; (4) discussion of benefits/risks; (5) discussion of uncertainties; (6) assessment of patient understanding; and (7) exploration of patient preference. We used a modified grounded theory approach to assess agreement with existing IDM elements and identify new elements.
  
  
  RESULTS
  In questionnaires, 97-100% of 59 participants rated each IDM element as "somewhat" or "very" important. Qualitative analysis supported existing elements and suggested two more: opportunity for input from trusted others, and discussion of decisions' impacts on patients' daily lives. Elements overlapped with global communication themes.
  
  
  CONCLUSIONS
  Focus groups affirmed existing IDM elements and suggested two more with particular relevance for older patients.
  
  
  CONCLUSIONS
  Incorporation of additional IDM elements into clinical practice can enhance informed participation of older adults in decision making.
authors.affiliation: Veterans Affairs Medical Center, San Francisco, CA 94121, USA. erika.price@ucsf.edu
authors.forename: Erika Leemann
authors.initials: EL
authors.lastname: Price
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bereknyei
authors.forename: Alma
authors.initials: A
authors.lastname: Kuby
authors.forename: Wendy
authors.initials: W
authors.lastname: Levinson
authors.forename: Clarence Henry
authors.initials: CH
authors.lastname: Braddock
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D007258:Informed Consent; D008297:Male; D016743:Mental Competency; D010358:Patient Participation / Q000639:trends; D010465:Perception; D010817:Physician-Patient Relations; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D035501:Uncertainty; D014743:Videotape Recording