What Matters Most is one of the 4 Ms of an Age-Friendly healtcare system. This “M” aligns care to what the patient feels is most important in their life.
Older patients, identified proxies, or caregivers/families/invested parties, in the community or healthcare setting.
Integrate geriatric-specific principles into the care of older individuals to maximize quality of life and care, and to align care-plans and care-goals with the wishes of the patient.
What Matters Most: This “M” aligns care to what the patient feels is most important in their life. It provides both an opportunity and a tool to communicate this information with family, surrogate decision makers, and the healthcare team. In doing so, it builds the central core for the other “M’s” of the IHI framework.
The framework creates a forum for difficult topic discussions such as:
- Approaches and limits to care (e.g., DNR, DNI, rehospitalization).
- Degree of invasiveness of therapies/treatments (e.g., surgery, chemotherapy, invasive nutrition support).
- Appropriateness of shifting towards palliative care measures or instituting other end of life care.
- Issues of independence (e.g., living arrangements, driving, personal goals).
- Describe the importance of identifying “what matters most” with a patient.
- Describe lead-in scripts to begin the conversation.
- Identify steps for a holding, and documenting the discussion.
- DeBartolo K, Saret C, Webster P. How to Have Conversations with Older Adults About “What Matters” A Guide for Getting Started. Institute for Healthcare Improvement.
- Institute for Healthcare Improvement. Age-Friendly Health Systems: Guide to Using the 4Ms in the Care of Older Adults. July 2020. http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Documents/IHIAgeFriendlyHealthSystems_GuidetoUsing4MsCare.pdf