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Values of older adults related to primary and secondary prevention

Author: Mary Butler; United States. Agency for Healthcare Research and Quality.; Minnesota Evidence-based Practice Center.
Publisher: Rockville, MD : Agency for Healthcare Research and Quality, [2011]
Series: Evidence synthesis/technology assessment, no. 84.; AHRQ publication, no. 11-05154-EF-1.
Edition/Format:   eBook : Document : National government publication : English
Summary:
OBJECTIVES: To inform the U.S. Preventive Services Task Force deliberations on recommendations around preventive care for older persons by assessing how older adults value the potential benefits of clinical preventive services, what attitudes older adults have about potential harms of clinical preventive services, how older adults understand the balance of risks and benefits of clinical preventive services, and how  Read more...
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Details

Genre/Form: Review
Material Type: Document, Government publication, National government publication, Internet resource
Document Type: Internet Resource, Computer File
All Authors / Contributors: Mary Butler; United States. Agency for Healthcare Research and Quality.; Minnesota Evidence-based Practice Center.
OCLC Number: 755055900
Notes: Title from PDF title pages (viewed Aug. 30, 2011).
"March 2011."
Description: 1 online resource.
Series Title: Evidence synthesis/technology assessment, no. 84.; AHRQ publication, no. 11-05154-EF-1.
Other Titles: Values of older adults related to prevention
Responsibility: prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Minnesota Evidence-based Practice Center ; investigators, Mary Butler [and others].

Abstract:

OBJECTIVES: To inform the U.S. Preventive Services Task Force deliberations on recommendations around preventive care for older persons by assessing how older adults value the potential benefits of clinical preventive services, what attitudes older adults have about potential harms of clinical preventive services, how older adults understand the balance of risks and benefits of clinical preventive services, and how clinicians should engage in shared decisionmaking related to clinical preventive services for older adults. DATA SOURCES: We searched Ovid MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsychINFO, the Cochrane Database of Systematic Reviews, and EconLit databases, and consulted with experts in the field. REVIEW METHODS: We selected English-language articles on preferences, lay understanding, choice behavior, patient/provider relationships, and shared decisionmaking regarding primary and secondary prevention that focused on a population aged 65 years and older. RESULTS: Very little literature exists addressing older people's perceived benefits and harms of preventive services, their decisional balance, and shared decisionmaking for preventive services. The literature identified in this review yielded a broad range of perceived benefits and harms for primary and secondary prevention, differing by those who had or had not received preventive services, the disease addressed by the intervention, and age group (e.g., the young old versus the old old). The values older adults placed on clinical preventive services were similarly variable and resistant to generalization. The literature on shared decisionmaking for preventive services for older adults demonstrated favorable response to such interventions and no indication whether older adults as a group have a different level of interest compared to other age groups. Not every older adult wants to engage in shared decisionmaking in the same way; clinicians need to determine how much an individual patient wants to be involved in his or her own screening choices. The studies largely used qualitative or descriptive analysis methods with small purposive samples. CONCLUSIONS: People's values for preventive services and their attendant benefits, risks, and harms reflect all sorts of inputs, including prior experiences, habits, strengths, and other idiosyncrasies. This individual variation makes generalizations dangerous. Patient-centered care may not always require shared decisionmaking; clinicians need to better understand how patients value their own role in clinical decisionmaking. Future research is needed in the field covered by this review, including exploration of differences between age groups within the older adult population, tools to measure values and preferences, and identification of what helps and hinders older adults' ability to engage in shared decisionmaking.

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