New elements for informed decision making: a qualitative study of older adults' views

Patient Educ Couns. 2012 Mar;86(3):335-41. doi: 10.1016/j.pec.2011.06.006. Epub 2011 Jul 14.


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.

Conclusion: Focus groups affirmed existing IDM elements and suggested two more with particular relevance for older patients.

Practice implications: Incorporation of additional IDM elements into clinical practice can enhance informed participation of older adults in decision making.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Communication
  • Decision Making*
  • Female
  • Focus Groups
  • Humans
  • Informed Consent*
  • Male
  • Mental Competency
  • Patient Participation* / trends
  • Perception
  • Physician-Patient Relations*
  • Qualitative Research
  • Surveys and Questionnaires
  • Uncertainty
  • Videotape Recording