Person-centeredness challenges us to authentically focus on what matters most to individuals. Decision-making with such a focus could be especially impactful for older adults who are living with frailty, multimorbidity, and fluctuating capacity. Our recent work tested a practical application of the theory: bringing a novel framework called Patient Priorities Care (PPC) into nurse practitioner (NP) education.

What Is “Patient Priorities Care”?

Aligned with the 4Ms Healthy Aging movement¹, Patient Priorities Care (PPC) is an evidenced-based, structured, person-centered approach that aligns healthcare with each patient’s values, specific health goals, and healthcare preferences. It aims to simplify complex care for older adults with multiple chronic conditions by:

• Eliciting what matters most to the patient and the outcomes they want from care.
• Translating those priorities into a clear “One Thing” focus to guide care decisions and conversations about trade-offs.
• Supporting shared decision-making and communication across the care team.

In our implementation, we delivered a five-part training that covered an introduction to PPC, identifying health priorities, practice with case studies, aligning care plans with those priorities, and decisional guidance using the “One Thing” strategy. Students learned both the principles and a practical process they can use in any visit. 

Why PPC Matters for Frailty

Apart from exercise, frailty treatments are still a source of much discussion and study. However, one thing is clear: most patients with frailty have complex multimorbidity, functional limitations, and multiple (sometimes divergent) recommendations from specialists. This combination increases the potential for unintended negative side effects from disease-specific practice guidelines interacting with one another.  How is a primary care provider supposed to navigate these stormy waters?  

The framework of Patient Priorities Care would reason that engaging with the patient’s own values and goals- informed by practice guidelines- can be a “north star” by which to guide conversations and decisions about the benefits and drawbacks of different treatment options. PPC creates a systematic way to discover and honor these preferences, reducing overtreatment or misaligned care.

Integrating the 4Ms into frailty discussions

PPC naturally operationalizes the 4Ms (What Matters, Medication, Mentation, and Mobility). By first clarifying What Matters as the first step, clinicians can right-size medications, tailor interventions to cognitive needs and capacity, and prioritize mobility goals that support the patient’s desired outcomes. This integration fosters care plans that are not only evidence-informed but also person-aligned.

From Concept to Practice: Building Clinician Skills

A conceptual commitment to “patient-centered care” isn’t enough. Clinicians need a reliable method to elicit priorities, translate them into action, navigate trade-offs, and communicate consistently with patients and teams. Our training emphasized practical interviewing strategies, non-linear elicitation over time, and how to use the “One Thing” to guide next steps. Notably, some learners still felt uncertain about applying PPC in clinic after the training sessions, signaling that didactic exposure should be paired with supervised practice.

Teach It Early: Embedding PPC in Training

Introducing PPC while clinicians are still in school can normalize a priorities-first workflow before habits form around guideline-centric checklists alone. It also supports equity: a structured approach to eliciting values and preferences is vital when caring for diverse populations whose priorities and lived contexts vary widely. We designed our curriculum using multi-modal content (videos, narrated slides, cases, and website-based materials) to help learners practice and reflect—an approach that students found accessible and feasible.

Our Study: Bringing PPC to NP Students

We evaluated the acceptability and feasibility of a PPC curriculum for two cohorts of Family NP and Adult–Gerontology NP students at the Johns Hopkins University School of Nursing. The five-part module introduced PPC principles and offered opportunities for practice with case scenarios, aligning care with identified priorities, and using the “One Thing” to guide decisions.

What We Found and Why It Matters to Clinicians

Strong understanding and perceived value:

• Over 90% of NP students endorsed understanding PPC and believed it would benefit their future patients.
• 98% planned to integrate PPC into their practice, indicating strong buy-in for day-to-day use.
• All students recognized the importance of helping patients identify what matters, discussing what patients are willing and able to do, and focusing on the “One Thing.”

Gaps to address:

• Only 74% identified teaching patients tips for communicating with their care team as part of PPC.
• Only 76% appreciated PPC’s flexibility and non-linearity in eliciting values over time.
• A meaningful minority reported a lack of confidence in applying PPC in clinic.

Clinical implications:

• Enthusiasm suggests PPC is immediately relevant to frontline decisions—especially in frailty, where trade-offs and goal-concordant outcomes are central.
• The gaps highlight where faculty and preceptors can focus: simulation with standardized patients, supervised clinical application, and explicit training on team communication and iterative goal setting.
• When implemented, PPC can streamline complex care by focusing visits and care plans on patient-defined outcomes—potentially improving satisfaction, reducing unwanted treatments, and enhancing adherence.

Looking Ahead

In brief, PPC is not an add-on. It is a way to practice that centers What Matters and operationalizes the 4Ms for the care of older adults and could be especially beneficial in frailty care. Training clinicians early to use PPC builds the skills and mindset needed to navigate complexity with clarity and compassion. That’s good for learners, good for clinicians, and, most importantly, good for older adults living with frailty.

To learn more about Patient Priorities Care, check out this website here: https://patientprioritiescare.org/

Citation: Hladek MD, Douglass B, Nettles B, Fingerhood M, Ling C, D’Aoust R, Tinetti ME. Incorporating patient priorities care curriculum for older adults with multiple chronic conditions into nurse practitioner education. Geriatr Nurs. 2026 Apr;69:103848. doi: 10.1016/j.gerinurse.2026.103848. Epub 2026 Jan 22. PMID: 41576859.

Supported by The John A. Hartford Foundation and NIH NIDDK K23DK133677.

1: Standing for What Matters, Medication, Mentation and Mobility, the 4Ms Health Friendly Aging Framework was developed by the John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States in 2017 (https://www.johnahartford.org/blog/view/discovering-the-4ms-a-framework-for-creating-age-friendly-health-systems).