Feb 2, 2021
The 4M's Framework: WHAT MATTERS with Tahira I. Lodhi MD
"WHAT MATTERS means knowing what's important to an older adult, so that we can align care to specific health outcomes and the care preferences that are including but not limited to end of life care and across all care settings." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN
Everyone involved in healthcare has their hands full most of the time—especially with COVID-19. Health care providers in an Age-Friendly Health System should ask older adults WHAT MATTERS to them - regardless of the care setting.
Today we are continuing the special series on the Age-Friendly Health Systems initiative and the 4M's Framework, explicitly discussing WHAT MATTERS.
Dr. Tahira Lodhi joins me, and she'll be expounding more about WHAT MATTERS as a vital component of an Age-Friendly Health System.
Part One of ‘The 4M's Framework: WHAT MATTERS'.
About Tahira I. Lodhi MD
Tahira I. Lodhi, MD, is an assistant professor in Geriatrics and Palliative Care at George Washington University. She graduated from medical school in 1999 and received her Family Medicine training at Virginia Commonwealth University and Geriatrics Fellowship Training at George Washington University.
Dr. Lodhi's interest is in geriatric primary care practice and teaching. Since graduating from Fellowship in Geriatrics in 2011, she has had medical students, residents, and fellows join her in traditional and non-traditional settings. These include hospitals, clinics, classrooms, assisted living, and post-acute long-term care settings.
Aside from that, she's also interested in workflow improvement in healthcare systems by deploying available technology. Her goal is to help her patients get simplified, patient-centered care while collaborating with an interdisciplinary team.
A Closer Look at WHAT MATTERS of the 4M's Framework
WHAT MATTERS means to know and align care with the older adult's specific health outcome goals and care preferences, including, but not limited to, end-of-life care and across care settings.
Why WHAT MATTERS is an Integral Aspect of Care?
When asked about this question, Dr. Tahira Lodhi explained that without WHAT MATTERS of the 4M's Framework, health care providers often lose sight of their patient's priorities.
She said, "I can sit here and prescribe whatever I want, but if my patient is not taking it, then I don't change anything. The outcomes do not change."
Creating that partnership with your patient is imperative to know what's essential for them as providers.
If you don't ask your patients what matters to them, you won't answer that question of their health. All of these play a role in WHAT MATTERS for your patients.
"Having conversations at a human level with your patient is very important. Keep in mind that your patient is not the labs or the diseases or diagnosis they have. They're a human being who wants to have a conversation with another human being." —Tahira Lodhi, MD
How to Initiate Conversation?
As a healthcare provider, in initiating conversations with your patients, keep in mind that this may not be one conversation that you can complete in one visit or one sitting. The critical piece is to start having those discussions. Your patients will appreciate it if you’re more open to communicating with them.
Start having conversations as simple as;
- What is most important to you?
- What can I do for you as a provider?
- What do you want me to do to help you make your quality of life better?
- Ask them if they miss a medication dose.
- What do you want to focus on while you are in the nursing home so that you can visit your grandchildren more often?
- What are your most important goals in case your health situation worsens?
Part Two of 'The 4M's Framework: WHAT MATTERS'.
The Essence of Documenting WHAT MATTERS to your Patients
It's crucial to document WHAT MATTERS to your patient, especially in your EHR (electronic health record). Also, when you organize your care plan around the 4M's, it easier for other providers to know which part to go to when they sift through the medical records.
Putting it in a place where other providers can see it quickly would be very important. Places, where you can put it, could be on a whiteboard for your patient in assisted living or a nursing home setting.
What to Include in the Documentation?
- Preferred name
- Preferred Pronouns
- Favorite Foods
- Favorite Activities
- Things that comfort the older adult
- Assistive Devices needed (glasses, dentures, hearing aids)
- Names and phone numbers of family members/ caregivers
"Care providers sometimes put our agenda aside. Our agenda doesn't matter so much if the person is unwilling or not ready to talk to us (about What Matters)." - Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN
What may Matter to an Older Adult and their Family?
It's essential to have information about WHAT MATTERS to an older adult and their family so that in cases of emergency, responders who don't know the patient can access that information and avoid an adverse outcome.
Examples of usual events or activities that may matter to an older adult and their family are;
- Babysitting a grandchild
- Walking/ exercising/ socializing with friends/ family
- Continuing to work or volunteer
- Life milestones (births, graduations, annual family celebrations)
- Travel Plans
- Birthdays
- Holidays
- Anniversaries
The Role of the Family
Geriatrics and palliative care are always interdisciplinary, and there's always a team that is taking care of your patient. That team includes not only your patient but their family members and their caregivers. Please make sure they are a part of the conversation.
While it's okay to include family members, be sure that the older adult is also asked WHAT MATTERS to them.
Implementing WHAT MATTERS to Older Adults with Cognitive Impairment or Alzheimer's Disease
In instances where the patient or an older adult cannot communicate for themselves, their advocates can. As healthcare providers, you should be advocates for your patients in all different settings.
For your patients who are not cognitively intact for any reason, maybe acute change, possibly chronic memory deficits, then their next of kin or power of attorneys should be aware of WHAT MATTERS to their patient. That way, they can make appropriate decisions for your patient according to what your patient wants and not what everyone dictates.
About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN]:
I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor, where I am also the Director of the GW Center for Aging, Health, and Humanities. Find out more about her work at https://melissabphd.com/.