also take personal characteristics into account

What have you researched?

‘We investigated the extent to which personal characteristics of elderly people play a role in joint decision-making. We were particularly interested in the influence of education, fear, vulnerability and health literacy on how older people experience shared decision-making and on their (un)certainty about the decision made. We also investigated what role patient participation during the conversation played in how elderly people experienced the decision-making process together afterwards and how certain or uncertain they felt about the decision made.’

How did you investigate that?

‘We analyzed data from 216 elderly people who had a consultation with the geriatrician at the geriatric outpatient clinic of the AMC, now Amsterdam UMC, or the former Slotervaart Hospital. We used questionnaires to map out the personal characteristics of the elderly in advance: their education, whether it was low, medium or high, how anxious they were, their vulnerability and their health skills. We made video recordings of the conversations and scored afterwards using the Observer OPTION^MCC , a measuring instrument for observing shared decision-making to what extent patients actively participated in the conversation. Afterwards, patients used scientific questionnaires (Collaborate and Decision Conflict Scale) to indicate how they had experienced joint decision-making and how certain they were about the decision that was made.’

What did you find striking?

‘Elderly people with a lower level of education and less fear appeared to be more positive about how they had experienced the process of joint decision-making afterwards. Older people with a higher level of education or limited health literacy or more anxiety were more uncertain about the decision. We saw that older people with older ages and limited health skills participated less actively in the conversations. What was most striking was that older people with limited health skills who actively participated in the discussions were less uncertain about the decision.’

And the conclusion?

‘When making joint decisions, it is important to take the personal characteristics of the elderly into account. This is especially true for older people with limited health literacy. If we can better involve them in joint decision-making, this will have a favorable effect on the outcomes, especially uncertainty about the decision.’

Finally, why is shared decision-making so important?

‘By making decisions together, elderly people feel more confident about the choices they make, are more motivated to continue treatment and are less likely to opt for treatments that do not contribute to their quality of life. I did PhD research. This shows that the doctor’s attention should not only be focused on the condition or complaint of the person in the treatment room, but also on the person himself. People with vulnerable health in particular experience all kinds of different complaints. The doctor should therefore not look at the condition individually, but at the whole picture. Then it is easier to decide together about what is really important for the patient.’