Eliciting and acting on “What Matters” as the foundation for age-friendly, person-centered care

Modern medicine relies heavily on clinical practice guidelines based on evidence from single-disease trials. However, these trials are typically not designed to meet the individual needs of older adults with multiple chronic conditions (MCC). Relying on disease-based guidelines in this population, who are often ineligible for clinical trials, is associated with unintended adverse outcomes, overly complex treatment plans, and care that does not match their goals, preferences or overall outlook on health.

The Age-Friendly Health Systems (AFHS) initiative was created to improve care for older adults in all healthcare settings by centering it around critical health, psychosocial, and functional considerations. AFHS adopts the 4Ms framework: What Matters, Medications, Mentation, and Mobility. Addressing What Matters, understanding a person’s health priorities and aligning care with those priorities, is the keystone M, but often the most difficult to successfully operationalize.

We wrote an article highlighting the Patient Priorities Care (PPC) framework. PPC provides clinicians a practical tool to identify what matters to each patient and use that knowledge to guide treatment decisions, including decisions about medication, mentation and mobility.

PPC can be divided into two core components: 1. Identifying health priorities and 2. Aligning care with health priorities, which are updated when significant life or health changes occur. This framework is especially useful in older adults with MCC, when health decisions are rarely simple. Instead, they often involve weighing trade-offs, such as whether the potential benefit of a new medication is worth the added side effects or treatment burden.

PPC helps patients and clinicians have structured conversations to clarify each patient’s top health priorities, preferred outcomes, and what they are willing and able to do in daily life. These discussions move beyond addressing a checklist of medical problems to focus on what matters most to the patient, making it easier to align treatments with an individual’s desired health goals and the care they are willing and able to receive.

Older adults can participate in the first portion of PPC independently, or with a care partner, using the myhealthpriorites.org website or a member of the medical team can work with the patient to explore their values; translate the values into specific, actionable, realistic health outcome goals; identify the most bothersome symptom or problem preventing achievement of the goal; and elicit what the older adult would be willing and able to do or receive to achieve the goal. Once clinicians discern this information, it is used to adjust care in the other AFHS domains to help the older adults achieve their health outcome goals linked to what matters.

Realigning healthcare decision-making around what matters to older adults with MCC, instead of a primary focus on single-disease-based guidelines, enables clinicians to consider the essential elements of AFHS (medications, mentation and mobility), function, meaningful activities, relationships and social determinants of health when developing treatment recommendations.

Research shows that this approach improves satisfaction for patients and clinicians, reduces unwanted or burdensome treatments and helps focus care on achievable goals. When participating in the PPC approach, patients feel more engaged and have greater confidence that their healthcare aligns with their values. PPC also is associated with reduced burnout among clinicians. The PPC framework provides a practical approach to making care truly patient-centered, particularly for older adults with MCC.

By starting with What Matters, clinicians can ensure that every treatment decision supports the outcomes patients value most, thereby restoring the focus of care to the whole person rather than the diagnosis.

By Drs. Angela Catic, associate professor, Section of Geriatrics and Palliative Medicine at Baylor College of Medicine and associate Chief of Staff for Education at the Michael E. DeBakey VA Medical Center; Katherine Ritchey, associate professor, Division of Geriatrics and Gerontology at University of Washington and associate director- Clinical, Geriatrics Research, Education and Clinical Center at the VA Puget Sound Health Care System; and Aanand D. Naik, professor and director, UTHealth Houston Institute on Aging and Investigator, Houston Center for Innovations in Quality, Effectiveness, and Safety at the Micheal E. DeBakey VA Medical Center