Moving Towards Patient-centered Care for Individuals with SMI using the What Matters Most – Structured Tool

Cindy Woolverton, PhD

Boston Veteran’s Administration Healthcare System
Moving Towards Patient-centered Care for Individuals with SMI using the What Matters Most – Structured Tool

Scientific Abstract

Background: Individuals diagnosed with serious mental illness (SMI) often experience symptoms that limit their level of functioning. They are at increased risk of developing comorbid medical conditions, resulting in greater risk of mortality. Individuals with SMI are often socially isolated and when receiving medical care may need decisional support by providers unfamiliar with their values. Initiatives exist to encourage advanced care planning, however these efforts focus largely on end of life care and do not address values related to healthcare for individuals with comorbidities. Recent efforts within geriatrics focus on aligning care for patients with comorbidities based on their healthcare values. Providers are in need of efficient tools that make care planning concrete to best deliver care that is patient-centered and fits within the patients values. We developed a two-page What Matters Most-Structured Tool (WMM-ST), which aims to guide individuals in reflection of healthcare values. The goal for our study is to assess the feasibility of using the WMM-ST in individuals with SMI.

Methods: Nine participants (mean age=62) with a SMI diagnosis completed the WMM-ST with a trained clinician. Clinicians then provided feedback related to feasibly and the process.

Results: Within 15 minutes most participants were able to complete the values tool, with general feedback suggesting additional writing space. While there was variability in responses, results show that participants found WMM-ST useful in identifying values in each domain. When asked to indicate top three values across domains, participants indicated that family relationships, religion and mobility were most important. As it relates to their healthcare decisions, all participants indicated that region was important yet there was variability in responses related to the impact of race and culture.

Majority of participants indicated that they prefer to make decisions collaboratively with their providers and family, and articulated who those individuals are in their lives.

Conclusions: Preliminary results suggest the WMM-ST is feasible for helping adults with SMI articulate values to guide their healthcare.

research Areas


Cindy B. Woolverton, PhD, Alexandra Kruk, LICSW, Jane A. Driver, MD, MPH, Julie M. Paik. MD, ScD, MPH, Jennifer Moye, PhD