Value Assessment in Healthcare Decision-Making of Ethnically and Cognitively Diverse Older Adults. (30th August 2019)

• Record Type: Journal Article
• Authors: Mejia, A; Smith, G D; Curiel, R E; Barker, W; Behar, R; Armstrong, M J
• Is Part Of: Archives of clinical neuropsychology. Volume 34:Number 7(2019)
• Page Start: 1260
• Page End: 1260
• Publication Date: 2019-08-30
• Subjects: Clinical neuropsychology -- Periodicals; 616.805
• DOI: 10.1093/arclin/acz029.27
• Languages: English
• ISSNs: 0887-6177

Abstract

Abstract: Objective: Little is known regarding the values that patients with mild cognitive impairment (MCI) incorporate into healthcare decision-making or how culture may affect such values. Even if values overlap across cultures, cultural groups may emphasize the importance of specific values differently since values emanate, at least in part, from cultural and life-long learning. The aim of this study was to explore and compare values that older adults of different ethnicities and cognitive statuses incorporate in their medical decisions. Participants and Method: Four focus groups were established by identifying older adults as, a) Hispanic or non-Hispanic, and with b) normal cognition or MCI. Participants were recruited from the 1Florida Alzheimer's Disease Research Center. Focus groups were audio-recorded and transcribed using a professional transcription service. Results: There were a total of 23 participants (Age: M = 70.9, SD = 6.4). MCI groups had briefer discussions (Time M = 44 minutes) than the normal cognition groups (Time M = 62 minutes). Qualitative analysis of discussions was used to explore the values identified across the focus groups. The MCI groups valued spirituality, doctor recommendations, and family involvement when facing medical decisions. Normal cognition groups valued the necessity of proactive involvement as healthcare consumers and the relationship between the quality of patient-clinician interaction and their health care related decisions. Cultural themes involving perceptions of gender and generational differences emerged from the Hispanic normal cognition group. Conclusions: This study identified many determinants influencing the medical decision-making process of diverse older adults: including past experiences, family involvement, healthcare barriers, and cultural background. These results have the potential to impact patient-clinician discussions, decisions made by surrogates, and the development of decision aids with a broader range of relevant patient values.