Methods to elicit and evaluate the attainment of patient goals in older adults: A scoping review

OBJECTIVE

This scoping review aimed to identify patient goal elicitation and evaluation methods for older adults, and to investigate which methods can be used in medication optimization interventions for nursing home residents (NHRs).

METHODS

The Arksey and O'Malley framework guided the review. A search was launched in PubMed, Embase, CINAHL, and Web of Science. Reference selection and data extraction were performed by three independent reviewers, followed by team discussions to solve discrepancies. Inductive thematic analysis was applied to synthesize the data. Included papers were reconsidered to identify methods for medication optimization interventions for NHRs.

RESULTS

Ninety-six references, encompassing 38 elicitation and 12 evaluation methods, were included. Elicitation methods differed in structure, content, and patient involvement levels. Qualitative and quantitative methods were found to assess goal attainment. Five elicitation and three evaluation methods were developed for NHRs, but none of these contained a medication-related assessment.

CONCLUSION

A variety of goal elicitation and evaluation methods for older adults was found, but none for medication optimization interventions in NHRs.

PRACTICE IMPLICATIONS

A holistic approach seems important to integrate patient goals into medication optimization interventions, not limiting goal elicitation to a medication-related assessment. Also, the choice of assessor seems important to obtain patient goals.

Care needs, social support and meaning in life in patients after acute heart failure hospitalisation: a longitudinal study

BACKGROUND

Meaning in life serves as a protective mechanism for coping with persistent, often distressful symptoms in patients with heart failure. However, meaning in life and its associated factors are not adequately explored in patients after acute hospitalisation for heart failure.

AIMS

To explore the associated factors of meaning in life in patients with heart failure from acute hospitalisation to 3 months post-discharge.

METHODS

A total of 103 hospitalised patients with heart failure in Northern Taiwan were recruited using a longitudinal study design and interviewed with structured questionnaires including meaning in life, symptom distress, care needs, and social support at hospitalisation, 1 month and 3 months post-discharge.

RESULTS

A total of 83 patients completed the 3 months follow-up. The presence of meaning in life significantly increased from hospitalisation to 3 months post-discharge. Decreases in care needs (B=-0.10, P=0.020) and social support (B=-0.18, P=0.016) from hospitalisation to 3 months post-discharge were significantly associated with an increase in the presence of meaning in life, while a decrease in social support was associated with an increase in the search for meaning in life (B=-0.17, P=0.034).

CONCLUSION

Care needs and social support were pivotal factors for developing meaning in life for patients with heart failure. Assessments of care needs and social support might help strengthen their meaning in life.

Empowered to Self-Care: A Photovoice Study in Patients With Heart Failure

Introduction: Heart failure–related hospitalization is preventable through self-care but remains a common cardiovascular reason for rehospitalization. The purpose of this study was to explore the promotion of self-care in Singaporean patients with heart failure. Method: A descriptive qualitative design was adopted using Photovoice. Sixteen participants with heart failure were recruited from an outpatient cardiology clinic in Singapore. The participants were asked to take photographs that represented their promotion of self-care and used them in the subsequent interviews. Data were transcribed verbatim and analyzed using thematic analysis. Results: Four themes emerged: (1) accepting life; (2) appreciating life; (3) maintaining meaning in life; and (4) establishing a new normal life. The four themes provided insights into how they empowered themselves to self-care. Discussion: Participants were empowered to self-care through active and passive processes. Self-reflection served as an active process internally. Support from health care providers served as a passive process externally.

Meaning in life and perceived quality of life in Switzerland: results of a representative survey in the German, French and Italian regions

BACKGROUND

The concept of meaning in life (MIL) has become a central one in recent years, particularly in psycho-oncology and palliative care. The Schedule for Meaning in Life Evaluation (SMILE) has been developed to allow individuals to choose the life areas that they consider to be important for their own MIL. This approach relates to the "World Health Organisation" definition of quality of life (QOL) as an individual's perception of his own position. The aims of this study were (i) to assess MIL in a representative sample of the Swiss population according to the three linguistic regions and (ii) to evaluate whether MIL constitutes a significant determinant of the perceived QOL.

METHODS

A telephone survey of the Swiss population, performed by a professional survey company, was conducted between November and December 2013. The interview included the SMILE, perceived QOL (0-10) and health status (1-5), and various sociodemographic variables. In the SMILE, an index of weighting (IOW, 20-100), an index of satisfaction (IOS, 0-100), and a total SMILE index (IOWS, 0-100) are calculated from the areas mentioned by the participants as providing MIL.

RESULTS

Among the 6671 telephonic contacts realized, 1015 (15%) participants completed the survey: 405 French, 400 German and 210 Italian participants. "Family" (80.2%), "occupation/work" (51%), and "social relations" (43.3%) were the most cited MIL-relevant categories. Italian participants listed "health" more frequently than German and French participants (50.4% vs 31.5% and 24.8% respectively, χ(2) = 12.229, p = .002). Age, gender, education, employment, and marital status significantly influenced either the MIL scores or the MIL-relevant categories. Linear regression analyses indicate that 24.3% of the QOL variance (p = .000) is explained by health status (B = .609, IC = .490-.728, p = .000), MIL (B = .034, IC = .028-.041, p = .000) and socioeconomic status (F = 11.01, p = .000).

CONCLUSION

The major finding of our analysis highlights the positive and significant influence of MIL on the perceived QOL in a representative sample of a general, multilingual and multicultural population. This result indicates that the existential dimension is not only determinant for QOL in some critical life events, as shown e.g. in psycho-oncology and palliative care, but also in everyday life.