title: Older Adults' Recognition of Trade-Offs in Healthcare Decision-Making.
abstract: OBJECTIVE
  To examine older persons' understanding of healthcare decision-making involving trade-offs.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Primary care clinics.
  
  
  METHODS
  Community-living persons aged 65 and older (N = 50).
  
  
  METHODS
  After being primed to think about trade-offs with a focus on chronic disease management, participants were asked to describe a decision they had made in the past involving a trade-off. If they could not, they were asked to describe a decision they might face in the future and were then given an example of a decision. They were also asked about communication with their primary care provider about their priorities when faced with a trade-off.
  
  
  RESULTS
  Forty-four participants (88%) were able to describe a healthcare decision involving a trade-off; 25 provided a decision in the past, 17 provided a decision they might face in the future, and two provided a future decision after hearing an example. One participant described a nonmedical decision, and two participants described goals without providing a trade-off. Of the healthcare decisions, 26 involved surgery, seven were end-of life decisions, seven involved treatment of chronic disease, and four involved chemotherapy. When asked whether their providers should know their health outcome priorities, 44 (88%) replied yes, and 35 (70%) believed their providers knew their priorities, but only 18 (36%) said that they had had a specific conversation about priorities.
  
  
  CONCLUSIONS
  The majority of participants were able to recognize the trade-offs involved in healthcare decision-making and wanted their providers to know their priorities regarding the trade-offs. Despite being primed to think about the trade-offs involved in day-to-day treatment of chronic disease, participants most frequently described episodic, high-stakes decisions including surgery and end-of-life care.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.|Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Siobhan M
authors.initials: SM
authors.lastname: Case
authors.affiliation: Program on Aging, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: John
authors.initials: J
authors.lastname: O'Leary
authors.affiliation: Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Tinetti
authors.affiliation: Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.|Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006292:Health Priorities; D006801:Humans; D008297:Male; D013727:Terminal Care / Q000458:organization & administration*
keywords: chronic disease; decision-making; trade-offs