One-third of people 50 and older report that their health care clinicians rarely or never take into account their care preferences. A person’s race, insurance status, and income level affect the quality of person-centered care they receive, according to a new report from the LeadingAge LTSS Center @UMass Boston and the Center for Consumer Engagement in Health Innovation.

Comparing data from the 2014, 2016, and 2018 Health and Retirement Study (HRS), the researchers found:

  • Black and Hispanic older adults are more likely to report never having their health preferences considered versus white adults. Twenty-four percent of Hispanic adults report never having their preferences considered. These figures compare with 7 percent of older white adults who report the same experience.
  • Individuals who report that their clinicians never account for their preferences are twice as likely to have incomes below the Federal Poverty Level ($12,140 for individuals) compared to those who report clinicians always take their preferences into account (23.5 percent to 12.3 percent respectively).

The report, “Person-Centered Care: Why Taking Individuals’ Care Preferences into Account Matters,” also explores practice and policy solutions to increase the availability of person-centered care. With support from the SCAN Foundation, the authors build on their earlier research which showed that negative consequences were likely to be associated with ignoring patient preferences for care.

“We found that being part of an underserved community or being poor are themselves risk factors for basically not having your preferences taken into account by health care providers,” says Marc Cohen, PhD, one of the four authors. Cohen serves as co-director of the LeadingAge LTSS Center @UMass Boston and research director of Community Catalyst’s Center for Consumer Engagement in Health Innovation. “Our analysis isolated the independent effect of race and income on the chance that someone would be listened to while holding other factors constant. This means that we can’t point to other issues such as education level or health status for example, as an excuse for not addressing issues related to race.”

Some people view person-centered care—which includes the way care is delivered, whether or not alternatives are offered, and how people experience the care—as a “nice to have” feature of the healthcare system, Cohen notes, but not something that is critical to the delivery of high quality care.

“This study and our prior study show that’s not really the case,” says Jane Tavares, PhD, research fellow at the LeadingAge LTSS Center @UMass Boston. “Bad things happen when people feel they are not being listened to, or that their preferences aren’t being met.” Looking at biomarkers included in the HRS data as objective measures of health, the researchers found that people who felt their preferences weren’t being heard were less likely to take preventive measures such as getting vaccines, less likely to engage with healthcare services overall, less likely to be managing their chronic conditions, most likely to have higher projected health care costs, and most likely to be disappointed in the healthcare system. “The end result is that you have bad health outcomes and projected higher healthcare costs,” Tavares says.

Training healthcare providers isn’t enough to resolve the issue, Cohen says. Improving person-centered care should be addressed for all sides, including allowing providers to spend more time with patients, supporting more consistent provident-patient relationships, building a stronger voice for healthcare consumers with such things as advisory councils( made up of patients and families), training consumers and providing toolkits to assure consumers can engage effectively with providers, changing the outcomes that we measure to assure that consumer experience is among them, and encouraging age friendly health care systems.

Joining Cohen and Tavares as authors of the report are Ann Hwang, MD, former director of Community Catalyst’s Center for Consumer Engagement in Health Innovation, and Frances Hawes PhD, assistant professor of health care administration at the University of Wisconsin, Eau Claire.

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