Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/105274
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Type: Journal article
Title: Influence of medication risks and benefits on treatment preferences in older patients with multimorbidity
Author: Caughey, G.
Tait, K.
Vitry, A.
Shakib, S.
Citation: Patient Preference and Adherence, 2017; 11:131-140
Publisher: Dove Medical Press
Issue Date: 2017
ISSN: 1177-889X
1177-889X
Statement of
Responsibility: 
Gillian E Caughey, Kirsty Tait, Agnes I Vitry, Sepehr Shakib
Abstract: Multimorbidity is associated with use of multiple medicines, increased risk of adverse events and treatment conflicts. This study aimed to examine how older patients with multimorbidity and clinicians balance the benefits and harms associated with a medication and in the presence of competing health outcomes. Interviews were conducted with 15 participants aged ≥65 years with 2 or more chronic conditions. Three clinical scenarios were presented to understand patient preference to take a medicine according to i) degree of benefit, ii) type of adverse event and impact on daily living and iii) influence of comorbid conditions as competing health outcomes. Semi-structured interviews were also conducted with participants (n=15) and clinicians (n=5) to understand patient preferences and treatment decisions, in the setting of multimorbidity. The median age of participants was 79 years, 55% had 5 or more conditions and 47% took 8 or more medicines daily. When the level of benefit of the medicine ranged from 14% to 70%, 80% of participants chose to take the medicine, but when adverse effects were present, this was reduced to 0-33% depending upon impact on daily activities. In the presence of competing health outcomes, 13%-26% of patients chose to take the medicine. Two-thirds of patients reported that their doctor respects and considers their preferences and discussed medication benefits and harms. Interviews with clinicians showed that their overall approach to treatment decision-making for older individuals with multimorbidity was based upon 2 main factors, the patients' prognosis and their preferences. The degree of benefit gained was not the driver of patients' preference to take a medicine; rather, this decision was influenced by type and severity of adverse effects. Inclusion of patient preferences in the setting of risks and benefits of medicines with consideration and prioritization of competing health outcomes may result in improved health outcomes for people with multimorbidity.
Keywords: Comorbidity; geriatrics; medicines; multimorbidity; patient decision-making; patient preference
Rights: © 2017 Caughey et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
RMID: 0030064814
DOI: 10.2147/PPA.S118836
Grant ID: http://purl.org/au-research/grants/nhmrc/1040938
Appears in Collections:Medicine publications

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