Qualitative exploration of how clinicians navigate divergence in older adult and family caregiver priorities

Clinicians often elicit and incorporate patient priorities into care plans. This process is complicated when patients and their family caregivers express incongruent priorities. We investigated patient and family caregiver priorities expressed during medical visits and clinician responses to divergent priorities. Methods: Our data consisted of four first-time medical appointments, each attended by an older patient, at least one family caregiver, and a team of geriatrics clinicians. We audio-recorded and transcribed the appointments, each lasting at least 120 min, and performed thematic analysis of the expressed priorities and clinician responses. Results: When incongruence in priorities emerged, clinicians responded with acknowledgement to each party’s priority and highlighted the incongruence itself, pointing out common ground when present, and pivoted to care planning, while exhibiting warmth and avoiding taking sides. Conclusions: Medical visits with patients and their family caregivers with divergent views present an opportunity for clinicians to promote candor and perspective-taking while finding common ground and assist throughout complex conversations. Further research should explore divergent priorities in larger patient samples with more diversity in cognitive ability and in varied healthcare settings.