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What Matters to Patients and Families: A Content and Process Framework for Clarifying Preferences, Concerns, and Values

Author

Listed:
  • Rhéa Rocque

    (School of Psychology, Laval University, Quebec City, QC, Canada)

  • Selma Chipenda Dansokho

    (Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada)

  • Roland Grad

    (Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
    Herzl Family Practice Centre, Jewish General Hospital, Montreal, QC, Canada)

  • Holly O. Witteman

    (Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada
    Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
    Research Centre in Sustainable Health (VITAM – Centre de recherche en santé durable), Quebec City, QC, Canada
    Research Center of the Laval University Academic Medical Centre (Centre de recherche du CHU de Québec-Université Laval), Quebec City, QC, Canada)

Abstract

Background. Values clarification, or sorting out what matters to a patient or family relevant to a health decision, is a fundamental part of shared decision making. We aimed to describe how values clarification occurs in routine primary care. Methods. Using framework analysis and an established taxonomy, 2 independent researchers analyzed 260 consultations in 5 family medicine clinics across Quebec. Two questions guided our analyses: 1) What categories exist regarding what matters to patients? 2) What patterns exist in discussions of what matters to patients? Results. 1) Five distinct categories of what matters to patients and families were discussed during values clarification: preferences, concerns, treatment-specific values, life goals or philosophies, and broader contextual or sociocultural values. Preferences and concerns were the matters most commonly raised. 2) Diverse patterns of values clarification emerged based on 3 analytical questions: Who initiates the discussion about what matters to patients? When? What information is discussed? The most frequent pattern was clinicians soliciting patients’ concerns and preferences during the information-gathering phase. The second most common pattern was similar, except that patients’ spontaneously raised what matters to them. Limitations. The study was descriptive and based on audio-recorded visits. We did not interview patients and clinicians to elicit their perspectives. Conclusions. There are 5 distinct categories of what matters to patients and families as well as clear patterns of how values clarification occurs in routine primary care consultations. Clinicians could be sensitive to these categories when engaging in the process of values clarification and may wish to pay particular attention to the opening minutes of a consultation. This study provides a structure for future identification of best practices in values clarification.

Suggested Citation

  • Rhéa Rocque & Selma Chipenda Dansokho & Roland Grad & Holly O. Witteman, 2020. "What Matters to Patients and Families: A Content and Process Framework for Clarifying Preferences, Concerns, and Values," Medical Decision Making, , vol. 40(6), pages 722-734, August.
    • Handle: RePEc:sae:medema:v:40:y:2020:i:6:p:722-734
    DOI: 10.1177/0272989X20940660
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    References listed on IDEAS

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    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    2. Yew Kong Lee & Wah Yun Low & Chirk Jenn Ng, 2013. "Exploring Patient Values in Medical Decision Making: A Qualitative Study," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-9, November.
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