Perspectives on Post-Stress Test Decision-Making and Preferred Outcomes Among Older Adults.

Importance: Among symptomatic older adults, noninvasive stress imaging is commonly used to assess for coronary artery disease. Comorbid geriatric conditions make an older adult population more vulnerable to complications of invasive testing and posttest treatment. Objective: To understand attitudes about post-stress imaging decision-making and preferred outcomes among older adults who had a stress test for suspected ischemic symptoms and their caregivers. Design, Setting, and Participants: In this qualitative study, focus groups were interviewed between July 2023 and March 2024. Focus groups included older adult patients (age ≥75 years) with recent cardiac stress imaging (within 12 months) at an urban academic hospital. Main Outcomes and Measures: The focus group facilitator guide addressed 3 domains: patient-physician communication during testing, patient preferences regarding decision-making and outcomes, and influence of geriatric impairments on decision-making. Thematic analysis used the constant comparative method to identify themes. Thematic saturation determined sample size. Results: A total of 8 focus groups were conducted with 29 participants (mean [SD] age, 79.0 [4.1] years; 17 [59%] women; 8 [28%] with ischemic stress test results). Regarding patient-physician communication, participants prioritized discussions of how age-related challenges might affect outcomes but felt that physicians rarely discussed these issues, provoking anxiety and confusion about test results. Participants desired more time, information, and support for informed decisions. Patients' trust in their physicians influenced the role they wanted to play in medical decision-making. Most patients felt responsible for managing their health, and caregivers served as important health care advocates. Patients reported that multiple chronic conditions, changes in functional and mental health status, and a strong desire to maintain independence shaped health goals. Quality of life often outweighed longevity, although individual preferences varied. Conclusions and Relevance: In this qualitative study of older adults who recently underwent stress testing, participants described limited communication about age-related concerns, valued physician and caregiver input, and prioritized maintaining quality of life and independence. These findings suggest that integrating geriatric assessment and patient-defined goals into shared decision-making might help guide more patient-centered care in this population.