title: Prognosis communication with older patients with multimorbidity: Assessment after an educational intervention.
abstract: This study aimed to assess how internal medicine residents incorporated prognosis to inform clinical decisions and communicated prognosis in primary care visits with older patients with multimorbidity after an educational intervention, and resident and patient perspectives regarding these visits. Assessment used mixed-methods. The authors assessed the frequency and content of prognosis discussions through residents' self-report and qualitative content analysis of audio-recorded clinic visits. The authors assessed the residents' perceived effect of incorporating prognosis on patient care and patient relationship through a resident survey. The authors assessed the patients' perceived quality of communication and trust in physicians through a patient survey. The study included 21 clinic visits that involved 12 first-year residents and 21 patients. Residents reported incorporating patients' prognoses to inform clinical decisions in 13/21 visits and perceived positive effects on patient care (in 11/13 visits) and patient relationship (in 7/13 visits). Prognosis communication occurred in 9/21 visits by self-report, but only in six of these nine visits by content analysis of audio-recordings. Patient ratings were high regardless of whether or not prognosis was communicated. In summary, after training, residents often incorporated patients' prognoses to inform clinical decisions, but sometimes did so without communicating prognosis to the patients. Residents and patients reported positive perceptions regarding the visits.
authors.affiliation: a Division of Geriatric Medicine and Gerontology, Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Schoenborn
authors.affiliation: a Division of Geriatric Medicine and Gerontology, Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Danelle
authors.initials: D
authors.lastname: Cayea
authors.affiliation: a Division of Geriatric Medicine and Gerontology, Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: McNabney
authors.affiliation: a Division of Geriatric Medicine and Gerontology, Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Anushree
authors.initials: A
authors.lastname: Ray
authors.affiliation: a Division of Geriatric Medicine and Gerontology, Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Boyd
mesh_terms: D000368:Aged; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D005853:Geriatrics / Q000193:education*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D000076322:Multimorbidity; D010817:Physician-Patient Relations; D011379:Prognosis
keywords: Curriculum assessment; multimorbidity; older adults; prognosis communication; resident education