Mariken Stegmann

Figure 1. Example of the Outcome Prioritisation (OPT) Tool. Note that in this example of the OPT, the  most important goal for this patient was to maintain independence.  Literature review  We will first discuss the articles reporting on the development of the OPT and thereafter  describe the literature review.   The OPT was developed using qualitative research among older patients with multiple  morbidities who were confronted with a trade‐off. It was first described in 2011. 11  Pilot  testing showed that participants understood the concept of prioritisation, but with a  maximum of four outcomes. 11  The OPT captured what is important for older people when  dealing with trade‐offs, but test‐retest validity was fair to poor. 11  Therefore, in a study  among residents of senior centres, the instruction accompanying the tool was changed in  order to emphasise the notion of trade‐offs. 14  This resulted in a test‐retest agreement  regarding the most and least important outcomes ranging from 85% to 100%. 14  Although the  testing was not performed in a clinical setting, the authors reported that maintaining  independence was most often prioritised as most important outcome, in 42‐76% of patients  (Table 1).  In PubMed the search terms Outcome priorit* tool and Health Outcome prior* were used  and in Web of Science we searched for articles that cited one of the development  articles. 11,14  The inclusion criterion was the use of the OPT.   32 Chapter 3