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Patient Priorities Care Microskills (Monograph)
Part 1: Identifying Values, Goals, and Priorities | Part 2: Applying Patient Priorities Care in Decision-Making
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Category: Adult-Gerontology, [Free CE for AANP Members], Cert Exam Domain - Assessment, Cert Exam Domain - Evaluation, Cert Exam Domain - Planning, Geriatrics, Gerontology, Health Promotion, Optum Recommended Education, Primary Care, Recent Additions (show less)
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Released: 09/02/2025
Expires: 09/30/2027 (subject to change)
- CE for this activity will not be available after this date.
 | This activity includes closed captioning. |
Delivery Note: The content for this activity is available in multiple delivery formats (OnDemand Video and Monograph Publication) in the AANP CE Center. Learners completing this activity should only complete ONE delivery-method to earn credit. Completing multiple delivery options for the same activity is considered duplicate credit for the same content and may not be accepted by some regulatory bodies.
Click here if you would like to take the OnDemand Video content instead.
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Overview
This two-part course introduces nurse practitioners and other clinicians to the principles and practice of Patient Priorities Care (PPC), an evidence-based approach designed to improve outcomes for patients with multiple chronic conditions (MCCs). Traditional disease-specific guidelines often fail to meet the needs of these patients, creating treatment burden, conflicting recommendations, and unintended harm. PPC addresses these challenges by aligning care with what matters most to each patient, their values, health outcome goals, top priorities, and healthcare preferences. Using case-based examples and practical scripts, participants will gain the skills to elicit patient values, translate them into realistic goals, identify the most bothersome problems interfering with those goals, and integrate trade-offs into shared decision-making. By the end of the course, learners will be prepared to apply PPC strategies in everyday clinical encounters to reduce unwanted care, improve patient engagement, and foster truly person-centered care.
Part 1: Identifying Values, Goals, and Priorities
Part 1 lays the foundation for implementing Patient Priorities Care by focusing on the first steps of aligning care with patient-identified values. Learners will explore the limitations of disease-based care for older adults with MCCs and discover how PPC reframes clinical decision-making around the "4Ms" of Age-Friendly Health Systems, with a central focus on What Matters. Through guided scripts and reflection, participants will practice eliciting patients’ most meaningful values, translating these into specific and actionable health outcome goals, and identifying the single top priority (the most bothersome problem interfering with a patient’s goals). Clinical cases, such as Mrs. B, illustrate how knowing what matters most can reshape care conversations and guide decision-making toward outcomes that are realistic, feasible, and deeply patient-centered.
Part 2 Course Description: Applying Patient Priorities Care in Decision-Making
Part 2 builds on the skills from Part 1 by teaching learners how to apply patient priorities in real-world care planning and clinical decision-making. Participants will learn how to assess medical, socioeconomic, and environmental contributors to patients’ most bothersome problems, integrate the Age-Friendly 4Ms framework, and develop interventions that are both effective and feasible. Strategies include deciding what to start, stop, or continue; engaging in trade-off conversations; and using "serial trials" when multiple options are possible. Emphasis is placed on aligning care teams around patients’ priorities, navigating differences among clinicians, and communicating transparently with patients and families. By the end of Part 2, learners will be equipped to consistently anchor care to patients’ goals and preferences, thereby fostering shared decision-making and reducing treatment burden.
Objectives - Part 1:
- Explain the challenges and tradeoffs involved in caring for patients with multiple conditions, functional limitations, and complex life circumstances than can be addressed by aligning care with patients’ priorities.
- Describe Patient Priorities Care, who it is for and how it aligns with the Age Friendly Health System (AFHS) 4Ms Framework.
- Use probes to identify patient’s most important and meaningful values, what matters most to them in their life and health.
- Differentiate between a patient's core health values and specific health outcome goals.
- Apply effective probing techniques to elicit and translate a patient's key health value into one to three specific, actionable, and realistic health outcome goals.
- Describe the role of a patient's top health priority in shared decision-making and apply effective strategies to elicit the priority during clinical encounters.
- Use prompts to identify healthcare interventions that a patient finds helpful and healthcare interventions a patient finds burdensome.
- Introduce the idea of trade-offs with patients and use prompts to explore potential willingness to try or retry potentially burdensome interventions.
- Part 2:
- Explain the rationale for using decision-making strategies that align with patients’ health priorities, including how these approaches support goal-concordant care and improved outcomes.
- Assess and integrate medical, socioeconomic, environmental, and other relevant factors to address the most bothersome problem interfering with a patient’s progress toward their health outcome goals.
- Select and apply appropriate medical, rehabilitative, palliative, socioeconomic, and environmental interventions to improve factors contributing to a patient’s most bothersome problem and support achievement of their health goals.
- Describe how to support patient-centered decision-making for individuals with MCCs by identifying and addressing trade-offs between patients’ personal goals and their healthcare preferences, including what they are willing and able to do to achieve desired outcomes.
- Integrate individual patients’ health priorities into healthcare communication and shared decision-making to ensure care aligns with what matters most to each person.
- Demonstrate strategies to identify and respond to common challenges when applying patient health priorities in communication and shared decision-making.
Speaker
Jennifer Ouellet, MDAssociate Professor of Medicine (Geriatrics); Co-director of Internal Medicine Resident Education and Director of Interprofessional Education, Geriatric Medicine, Yale School of MedicineAuthors/Contributors
Mary Tinetti, MD - Gladys Phillips Crofoot Professor of Medicine (Geriatrics) and Professor in the Institution for Social and Policy Studies, Yale School of Medicine
Brenda S. Nettles, DNP, MS, ACNP-BC, AOCNP, CNE - Assistant Professor, Johns Hopkins School of Nursing
Loni Belyea, MD, MBA - Chief Medical Officer, Hello Alpha
Natalie Sanders, DO - Associate Professor, Department of Internal Medicine, Geriatrics Division, University of Utah
Eliza Kiwak, MS – Associate Director, Internal Medicine (Geriatrics), Yale School of Medicine
Melissa deCardi Hladek PhD, FNP-BC, FAAN – Assistant Professor, Johns Hopkins School of Nursing
Angela Catic, M.D., M.Ed. - Associate Chief of Staff for Education, Michael E. DeBakey VA Medical Center
Disclosure
This program was planned in accordance with AANP CE Standards and Policies.The speaker/authors/contributors have the following disclosures: - Dr. Hladek: Fresenius-consultant
All relevant financial relationships have been mitigated.All other faculty and activity planners involved in this activity have no relevant financial relationships to disclose.This work is funded by the John A. Hartford Foundation and the HRSA COACH 4M project.
Disclaimer
Individuals who have contributed to the CE Center were carefully selected for their knowledge and experience in the subject area under review. This presentation is informational only and may contain opinions of the authors from their personal experience that do not necessarily express the opinions of the American Association of Nurse Practitioners (AANP). The activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Clinical practice is a constantly changing process and new information becomes available every day. Neither AANP nor the contributing individuals can warrant that the material will continue to be accurate, nor do they warrant that the material is completely free of errors upon publication. Attendees and participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.
CE Credit Instructions- Read this activity description, including objectives and disclosures.
- Complete the educational content:
- Monograph Publication - Part 1:
- Click the Play button to access the PDF file. Full participation credit for the activity is achieved after you have read the entire article.
- Click on the Additional Resources button to review all additional materials provided (handouts, post-test reviews, any other downloadable resources).
- Click on the blue Next Steps button and click I Agree on the affidavit statement. Click on Get Certificate and you will receive a message directing you to proceed to Part 2.
- Monograph Publication - Part 2:
- Click the Play button to access the PDF file. Full participation credit for the activity is achieved after you have read the entire article.
- Click on the Additional Resources button to review all additional materials provided (handouts, post-test reviews, any other downloadable resources).
- Click on the blue Next Steps button and click I Agree on the affidavit statement. Click on Get Certificate and you will receive a message directing you back to the parent module (top activity block of the activity).
- Activity Post-Test and Evaluation:
- Click on the Next Steps button from the parent module (top activity block of the activity) and complete the activity post-test and evaluation to receive continuing education credit for this activity.
Additional Information
For questions or more information concerning this online CE activity, please visit the AANP Help Center to find answers to frequently asked questions and request assistance.
| 1.5 Contact Hour(s) of CE |
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