Health outcome prioritization to elicit preferences of older persons with multiple health conditions

ObjectiveTo develop and test a simple tool to elicit the preferences of older persons based on prioritization of universal health outcomes.MethodsPersons age ≥65 participating in a larger study were asked to rank 4 outcomes on a visual analogue scale: (1) maintaining independence, (2) staying alive, (3) reducing/eliminating pain, (4) reducing/eliminating other symptoms.ResultsInterviewers rated 73% of the 81 participants as having good to excellent understanding, and cognitive interviews demonstrated the tool captured how participants thought about trade-offs. Test-retest reliability was fair to poor for ranking most of the outcomes as either most or least important (kappa .28–1.0). Patient characteristics associated with ranking “keeping you alive” as most important have been shown to be associated with a preference for life-sustaining treatment, a related construct. There was substantial variability in the outcome ranked as most important.ConclusionsThe task of ranking 4 universal health outcomes was well understood, captured what was important when considering trade-offs, and demonstrated content validity. However, test-retest reliability was fair to poor.