# Physician Characteristics Associated with Prioritizing Treatment Burden in Outpatient Care for Older Adults with Multimorbidity

## TL;DR

This study explores which physician traits are linked to prioritizing treatment burden in older patients with multiple health issues.

## Contribution

The study introduces a new scale to assess treatment burden prioritization and identifies sex as a key factor influencing it.

## Key findings

- A new six-item scale for assessing treatment burden prioritization showed good validity and consistency.
- Female physicians were more likely to prioritize treatment burden compared to male physicians.
- Years of experience and practice setting had no significant impact on prioritizing treatment burden.

## Abstract

Older adults with multimorbidity often experience substantial treatment burden, which can compromise their quality of life and adherence to medical treatment. Accordingly, physicians need to prioritize treatment burden. However, physician characteristics associated with prioritization of treatment burden among older adults with multimorbidity in outpatient care remain unclear. This study aimed to: (1) develop a brief, clinician-oriented scale to assess prioritization of treatment burden in outpatient settings and evaluate its reliability and exploratory validity; and (2) examine associations between prioritizing treatment burden and physician attributes in Japan.

We conducted an anonymous postal survey in June and July 2022 targeting 3,300 physicians affiliated with the Japan Geriatrics Society or the Japan Primary Care Association. Physicians’ prioritization of treatment burden was assessed using a newly developed six-item scale. After evaluating the scale’s reliability and validity, we dichotomized participants by the median score and used modified Poisson regression to analyze associations between prioritizing treatment burden and physician characteristics (sex, years of experience, and practice setting).

Responses from 688 physicians who provided outpatient care were analyzed. The scale demonstrated good construct validity and internal consistency (Cronbach’s alpha = 0.771). Female physicians were significantly more likely to prioritize treatment burden than male physicians (model 1: prevalence ratio [PR] 1.204, 95% confidence interval [CI]: 1.084-1.336; model 2: PR 1.202, 95% CI: 1.082-1.335). No significant associations were found between prioritizing treatment burden and years of clinical experience or practice environment (e.g., facility type, patient age distribution).

The newly developed clinician-oriented scale demonstrated exploratory validity for assessing physicians’ prioritization of treatment burden. Furthermore, prioritization of treatment burden was more strongly associated with personal attributes―particularly sex―than with clinical experience or practice setting. These findings underscore the need for educational interventions to enhance physicians’ awareness of treatment burden.