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Prieto J, Wilson J, Tingle A, Cooper E, Handley M, Rycroft Malone J, Bostock J, Loveday H. Preventing urinary tract infection in older people living in care homes: the 'StOP UTI' realist synthesis. BMJ Qual Saf 2024:bmjqs-2023-016967. [PMID: 39122359 DOI: 10.1136/bmjqs-2023-016967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Urinary tract infection (UTI) is the most diagnosed infection in older people living in care homes. OBJECTIVE To identify interventions for recognising and preventing UTI in older people living in care homes in the UK and explain the mechanisms by which they work, for whom and under what circumstances. METHODS A realist synthesis of evidence was undertaken to develop programme theory underlying strategies to recognise and prevent UTI. A generic topic-based search of bibliographic databases was completed with further purposive searches to test and refine the programme theory in consultation with stakeholders. RESULTS 56 articles were included in the review. Nine context-mechanism-outcome configurations were developed and arranged across three theory areas: (1) Strategies to support accurate recognition of UTI, (2) care strategies for residents to prevent UTI and (3) making best practice happen. Our programme theory explains how care staff can be enabled to recognise and prevent UTI when this is incorporated into care routines and activities that meet the fundamental care needs and preferences of residents. This is facilitated through active and visible leadership by care home managers and education that is contextualised to the work and role of care staff. CONCLUSIONS Care home staff have a vital role in preventing and recognising UTI in care home residents.Incorporating this into the fundamental care they provide can help them to adopt a proactive approach to preventing infection and avoiding unnecessary antibiotic use. This requires a context of care with a culture of personalisation and safety, promoted by commissioners, regulators and providers, where leadership and resources are committed to support preventative action by knowledgeable care staff.
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Affiliation(s)
| | - Jennie Wilson
- Richard Wells Research Centre, University of West London-Brentford Site, Brentford, UK
| | - Alison Tingle
- Richard Wells Research Centre, University of West London-Brentford Site, Brentford, UK
| | | | | | | | | | - Heather Loveday
- Richard Wells Research Centre, University of West London-Brentford Site, Brentford, UK
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2
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Buck D, Mulligan LD, Lennox C, Bowden J, Minchin M, Kemp L, Devine L, Southworth J, Ghafur F, Robinson C, Shepherd A, Shaw JJ, Forsyth K. Developing an initial programme theory for a model of social care in prisons and on release (empowered together): A realist synthesis approach. MEDICINE, SCIENCE, AND THE LAW 2024:258024241264762. [PMID: 39052987 DOI: 10.1177/00258024241264762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Many people are living in prison with a range of social care needs, for example, requiring support with washing, eating, getting around safely, and/or maintaining relationships. However, social care for this vulnerable group is generally inadequate. There is uncertainty and confusion about who is legally responsible for this and how it can best be provided, and a lack of integration with healthcare. We used realist-informed approaches to develop an initial programme theory (IPT) for identifying/assessing social care needs of, and providing care to, male adults in prison and on release. IPT development was an iterative process involving (a) an initial scoping of the international prison literature; (b) scoping prison and community social care policy documents and guidelines; (c) full systematic search of the international prison social care literature; (d) insights from the community social care literature; (e) stakeholder workshops. Information from 189 documents/sources and stakeholder feedback informed the IPT, which recommended that models of prison social care should be: trauma-informed; well integrated with health, criminal justice, third-sector services and families; and person-centred involving service-users in all aspects including co-production of care plans, goals, and staff training/awareness programmes. Our IPT provides an initial gold standard model for social care provision for people in prison and on release. The model, named Empowered Together, will be evaluated in a future trial and will be of interest to those working in the criminal justice system, care providers and commissioners, local authorities, housing authorities, voluntary groups, and service-users and their families.
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Affiliation(s)
- Deborah Buck
- Social Care and Society, University of Manchester, Manchester, UK
| | - Lee D Mulligan
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Charlotte Lennox
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Jana Bowden
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Matilda Minchin
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Lowenna Kemp
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Lucy Devine
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | | | | | - Andrew Shepherd
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Jennifer J Shaw
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Katrina Forsyth
- Social Care and Society, University of Manchester, Manchester, UK
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3
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Doan TTT, Kim J, Kim H, An W, Seo E, Park M. Decision Regret and Decision-Making Process among Caregivers of Older Adults Receiving Home Care: A Cross-Sectional Study. J Am Med Dir Assoc 2024; 25:105166. [PMID: 39043248 DOI: 10.1016/j.jamda.2024.105166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES Family caregivers of older adults receiving home care often find themselves in situations in which they must make important and difficult decisions, which can cause conflict and regret. To tailor shared decision making in this context, we aimed to identify the most difficult decisions they faced, assess their levels of decision regret, and explore the associated factors. DESIGN This study used a cross-sectional design. SETTING AND PARTICIPANTS Participants included 165 caregivers of older adults who received home care services in Korea. METHODS We identified difficult decisions perceived by family caregivers of older adults and evaluated decision regret using the Decision Regret Scale (DRS), decisional conflict using the Decisional Conflict Scale (DCS), burden of care using the Short Zarit Burden Inventory, and Preference Control Scale (PCS). We then performed descriptive, bivariate, and multivariate linear regression analyses to identify factors predicting decision regret. RESULTS The most frequently reported difficult decisions were related to place of living (71.6%), management of health conditions (15.1%), and end-of-life decisions (13.3%). The mean DCS score was 37.09 (12.67), the DRS score was 32.33 (15.91), and the burden score was 21.81 (8.25). Matching decisions with preferences and aligning decision-making roles significantly reduced regret, while decision conflicts increased regret. CONCLUSIONS AND IMPLICATIONS The positive associations between decision regret, decision conflict, and the alignment of decision-making roles highlight the intricate dynamics involved in the decision-making process for family caregivers. These findings emphasize the need for tailored interventions that recognize and address the diverse factors influencing caregivers' decision-making experiences. Future research exploring the efficacy of targeted interventions such as decision-support programs or caregiver education initiatives could offer valuable insights into mitigating decision-related challenges and improving the overall well-being of both caregivers and care recipients.
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Affiliation(s)
- Thao Thi-Thu Doan
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea; Faculty of Nursing, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Jinju Kim
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Heejung Kim
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Wonmi An
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Eunkyung Seo
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Myonghwa Park
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
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4
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Kong Y, Liu XW, Cui QQ, Xu H, Ali S. Resolving conflict and promoting coordination for an integrated old-age healthcare service system in China: GMCR-AHP based decision analysis approach. Heliyon 2024; 10:e33470. [PMID: 39050468 PMCID: PMC11267044 DOI: 10.1016/j.heliyon.2024.e33470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 06/10/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
China faces a healthcare challenge due to its aging population, necessitating an integrated old-age healthcare system considering multiple stakeholders' interests. Conflict and inequality may arise from varying stakeholder interests. This study develops a conflict resolution strategy for the coordination of stakeholders involved in the old-age healthcare service system, promoting harmonization and minimizing conflict to establish an equitable system meeting elderly needs. It contributes to a robust healthcare system for comprehensive, quality care. The focus of the study is to identify relevant stakeholders and decision-makers involved in developing an integrated old-age healthcare service system and explore a feasible solution through stakeholder analysis using the Mitchell score-based technique and stakeholder theory. Decision-makers' preferences are estimated using the Analytic Hierarchy Process (AHP). Solution strategies are developed through multiple stability concepts within the graph model for conflict resolution (GMCR). The conflict resolution analysis based on the integrated AHP-GMCR approach reveals that the development of an integrated old-age healthcare system is feasible by addressing potential conflicts among the stakeholders. Considering the current predicament of comprehensive medical services in China, governments should distribute authority, simplify procedures, and improve the insurance system. Furthermore, medical institutions should explore funding options, expand services, and enhance accessibility. Elderly individuals should prioritize healthy aging and seek suitable healthcare providers. Stakeholder participation is crucial for effective implementation. These recommendations enable China to advance integrated elderly care successfully, addressing challenges posed by the aging population.
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Affiliation(s)
- Yang Kong
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
- College of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, Jiangsu, China
| | - Xue-Wei Liu
- Eye Institute of Shandong First Medical University, Qingdao, N250000, Shandong, China
| | - Qian-Qian Cui
- Medical Insurance Management Office, Zibo Central hospital, 255020, China
| | - Haiyan Xu
- College of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, Jiangsu, China
| | - Sharafat Ali
- College of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, Jiangsu, China
- Department of Economics, Ghazi University, Dera Ghazi Khan, Punjab, Pakistan
- University of Layyah, Layyah, 31200, Pakistan
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Khemai C, Leão DLL, Janssen DJA, Schols JMGA, Meijers JMM. Interprofessional collaboration in palliative dementia care. J Interprof Care 2024; 38:675-694. [PMID: 38757957 DOI: 10.1080/13561820.2024.2345828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Interprofessional collaboration (IPC) is essential for high-quality palliative care (PC) for persons with dementia. The aim of this scoping review was to identify IPC approaches in palliative dementia care and explore the elements constituting these approaches. We performed a search in PubMed, CINAHL, and PsychINFO using the Joanna Briggs Institute Reviewers' manual and PRISMA guidelines, and conducted content analysis of the included articles. In total, 28 articles were included, which described 16 IPC approaches in palliative dementia care. The content analysis revealed three overall elements of these approaches: 1) collaborative themes, 2) collaborative processes, and 3) resources facilitating collaboration. Frequently reported collaborative themes embraced pain management and providing care in the dying phase. These themes were addressed through intertwined collaborative processes including communication, coordination, assessing and monitoring, and reflecting and evaluating. To ensure optimal IPC in palliative dementia care, various resources were required, such as PC knowledge, skills to manage symptoms, skills to communicate with collaborators, and a facilitating environment. In conclusion, the identified IPC approaches in palliative dementia care involve diverse collaborating professionals who mainly manage symptoms, prepare for the dying phase and require material and immaterial resources to enable optimal IPC in palliative dementia care.
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Affiliation(s)
- C Khemai
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - D L L Leão
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - D J A Janssen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Department of Research and Development, Ciro, Horn, the Netherlands
| | - J M G A Schols
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - J M M Meijers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Zuyderland Care, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
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Berkhout-Byrne NC, Voorend CGN, Meuleman Y, Mooijaart SP, Brunsveld-Reinders AH, Bos WJW, Van Buren M. Nephrology-tailored geriatric assessment as decision-making tool in kidney failure. J Ren Care 2024; 50:112-127. [PMID: 37031361 DOI: 10.1111/jorc.12466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/26/2023] [Accepted: 03/16/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Dialysis might not benefit all older patients with kidney failure, particularly those with multimorbid conditions and frailty. Patients' and healthcare professionals' awareness of the presence of geriatric impairments could improve outcomes by tailoring treatment plans and decisions for individual patients. OBJECTIVE We aimed to explore the perspectives of patients and healthcare professionals on nephrology-tailored geriatric assessment to fuel decision-making for treatment choices in older patients with kidney failure. DESIGN In an exploratory qualitative study using focus groups, participants discussed perspectives on the use and value of nephrology-tailored geriatric assessment for the decision-making process to start or forego dialysis. PARTICIPANTS AND MEASUREMENTS Patients (n = 18) with kidney failure, caregivers (n = 4), and professionals (n = 25) were purposively sampled from 10 hospitals. Interviews were audio-recorded, transcribed verbatim and inductively analysed using thematic analysis. RESULTS Three main themes emerged that supported or impeded decision-making in kidney failure: (1) patient psycho-social situation; (2) patient-related factors on modality choice; (3) organisation of health care. Patients reported feeling vulnerable due to multiple chronic conditions, old age, experienced losses in life and their willingness to trade longevity for quality of life. Professionals recognised the added value of nephrology-tailored geriatric assessment in three major themes: (i) facilitating continual holistic assessment, (ii) filling the knowledge gap, and (iii) uncovering important patient characteristics. CONCLUSIONS nephrology-tailored geriatric assessment was perceived as a valuable tool to identify geriatric impairments in older patients with kidney failure. Integration of its outcomes can facilitate a more holistic approach to inform choices and decisions about kidney replacement therapy.
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Affiliation(s)
- Noeleen C Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Carlijn G N Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Willem Jan W Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolijn Van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Haga Hospital, The Hague, The Netherlands
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7
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Molendijk-van Nieuwenhuyzen K, Belt-van Opstal R, Hakvoort L, Dikken J. Exploring geriatric trauma unit experiences through patients' eyes: a qualitative study. BMC Geriatr 2024; 24:476. [PMID: 38816688 PMCID: PMC11140891 DOI: 10.1186/s12877-024-05023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION The surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit's emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization. METHODS This qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed. RESULTS The findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit. CONCLUSION Effective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.
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Affiliation(s)
| | | | | | - Jeroen Dikken
- De Haagse Hogeschool, Faculteit Gezondheid, Voeding & Sport, Johanna Westerdijkplein 75, 2521 EN, The Hague, The Netherlands
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8
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Faulkner L, Hughes CM, Barry HE. 'I think we could probably do more': an interview study to explore community pharmacists' experiences and perspectives of frailty and optimising medicines use in frail older adults. Age Ageing 2024; 53:afae089. [PMID: 38706393 PMCID: PMC11070721 DOI: 10.1093/ageing/afae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Community pharmacists potentially have an important role to play in identification of frailty and delivery of interventions to optimise medicines use for frail older adults. However, little is known about their knowledge or views about this role. AIM To explore community pharmacists' knowledge of frailty and assessment, experiences and contact with frail older adults, and perceptions of their role in optimising medicines use for this population. METHODS Semi-structured interviews conducted between March and December 2020 with 15 community pharmacists in Northern Ireland. Interviews were transcribed verbatim and analysed thematically. RESULTS Three broad themes were generated from the data. The first, 'awareness and understanding of frailty', highlighted gaps in community pharmacists' knowledge regarding presentation and identification of frailty and their reluctance to broach potentially challenging conversations with frail older patients. Within the second theme, 'problem-solving and supporting medication use', community pharmacists felt a large part of their role was to resolve medicines-related issues for frail older adults through collaboration with other primary healthcare professionals but feedback on the outcome was often not provided upon issue resolution. The third theme, 'seizing opportunities in primary care to enhance pharmaceutical care provision for frail older adults', identified areas for further development of the community pharmacist role. CONCLUSIONS This study has provided an understanding of the views and experiences of community pharmacists about frailty. Community pharmacists' knowledge deficits about frailty must be addressed and their communication skills enhanced so they may confidently initiate conversations about frailty and medicines use with older adults.
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Affiliation(s)
- Lucy Faulkner
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - Heather E Barry
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, UK
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9
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McGlacken-Byrne SM, Murphy NP, Barry S. A realist synthesis of multicentre comparative audit implementation: exploring what works and in which healthcare contexts. BMJ Open Qual 2024; 13:e002629. [PMID: 38448042 PMCID: PMC10916097 DOI: 10.1136/bmjoq-2023-002629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Multicentre comparative clinical audits have the potential to improve patient care, allow benchmarking and inform resource allocation. However, implementing effective and sustainable large-scale audit can be difficult within busy and resource-constrained contemporary healthcare settings. There are little data on what facilitates the successful implementation of multicentre audits. As healthcare environments are complex sociocultural organisational environments, implementing multicentre audits within them is likely to be highly context dependent. OBJECTIVE We aimed to examine factors that were influential in the implementation process of multicentre comparative audits within healthcare contexts-what worked, why, how and for whom? METHODS A realist review was conducted in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards reporting standards. A preliminary programme theory informed two systematic literature searches of peer-reviewed and grey literature. The main context-mechanism-outcome (CMO) configurations underlying the implementation processes of multicentre audits were identified and formed a final programme theory. RESULTS 69 original articles were included in the realist synthesis. Four discrete CMO configurations were deduced from this synthesis, which together made up the final programme theory. These were: (1) generating trustworthy data; (2) encouraging audit participation; (3) ensuring audit sustainability; and (4) facilitating audit cycle completion. CONCLUSIONS This study elucidated contexts, mechanisms and outcomes influential to the implementation processes of multicentre or national comparative audits in healthcare. The relevance of these contextual factors and generative mechanisms were supported by established theories of behaviour and findings from previous empirical research. These findings highlight the importance of balancing reliability with pragmatism within complex adaptive systems, generating and protecting human capital, ensuring fair and credible leadership and prioritising change facilitation.
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Affiliation(s)
| | - Nuala P Murphy
- Department of Paediatric Endocrinology, Children's Health Ireland at Temple Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Sarah Barry
- RCSI School of Population Health, Dublin, Ireland
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10
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Dijkman BL, Luttik ML, van der Wal-Huisman H, Paans W, van Leeuwen BL. Involvement of family members of older patients with cancer in triadic decision-making processes during medical consultations on an outpatient ward - an observational exploratory study using quantitative and qualitative methods. J Geriatr Oncol 2024; 15:101699. [PMID: 38217956 DOI: 10.1016/j.jgo.2023.101699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/26/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION There is a growing interest in the involvement of family members of older patients with cancer in decision-making processes. The aim of this study is to identify how and to what extent family members, together with patients and physicians, are involved in triadic decision-making processes in clinical practice. MATERIALS AND METHODS This study was conducted using an exploratory observational design. The Observer Patient Involvement Scale for patients with Multiple Chronicle Conditions (OPTIONMCC) was used to assess the interaction in triadic decision-making between patients, family members, and physicians. Physicians' behaviour was scored on a Likert-scale ranging from 0 (not observed) to 4 (executed to a high standard), while the behaviour of patients and their family members was scored on a scale from 0 (no or minimum participation) to 2 (active participation). Atlas.ti software was used to facilitate coding, and the SPSS statistical analysis platform was used to explore correlations between the shared decision-making (SDM) skills of the physician and the participation of patients and their family members. RESULTS In total, ten physicians performed 25 consultations with older patients and 30 family members. Patients showed higher levels of participation in the SDM process than family members (OPTIONMCC mean scores 0.96 vs 0.61). Physicians' SDM skills were observed at a low or moderate skill level (OPTIONMCC mean score 1.81). Exploratory correlation analysis showed that higher physician scores were related to higher levels of both patients' and family members' involvement in the decision-making process. The level of family members' involvement in SDM varied from no involvement at all to active involvement. Qualitative analysis of family involvement revealed that relatives are likely to: emphasize patients' values and goals of care; inquire about different treatment options; assist in the deliberation process; and ask for clarification of the further medical process. Physicians showed responsive behaviour towards family members but seldom actively involved them in the SDM process. DISCUSSION The study findings suggest that there is a need to include strategies to facilitate family involvement in current SDM models for older patients with cancer. Healthcare professionals in geriatric oncology might benefit from additional training covering family dynamics and managing challenging situations.
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Affiliation(s)
- Bea L Dijkman
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, P.O.Box 3109, 9701 DC Groningen, the Netherlands; Department of Surgery, Groningen University, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, the Netherlands.
| | - Marie Louise Luttik
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, P.O.Box 3109, 9701 DC Groningen, the Netherlands.
| | - Hanneke van der Wal-Huisman
- Department of Surgery, Groningen University, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, the Netherlands.
| | - Wolter Paans
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, P.O.Box 3109, 9701 DC Groningen, the Netherlands.
| | - Barbara L van Leeuwen
- Department of Surgery, Groningen University, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, the Netherlands.
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11
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Klingberg S, Adhikari B, Draper CE, Bosire E, Nyirenda D, Tiigah P, Mukumbang FC. Enhanced or hindered research benefits? A realist review of community engagement and participatory research practices for non-communicable disease prevention in low- and middle-income countries. BMJ Glob Health 2024; 9:e013712. [PMID: 38341191 PMCID: PMC10862340 DOI: 10.1136/bmjgh-2023-013712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Community engagement and participatory research are widely used and considered important for ethical health research and interventions. Based on calls to unpack their complexity and observed biases in their favour, we conducted a realist review with a focus on non-communicable disease prevention. The aim was to generate an understanding of how and why engagement or participatory practices enhance or hinder the benefits of non-communicable disease research and interventions in low- and middle-income countries. METHODS We retroductively formulated theories based on existing literature and realist interviews. After initial searches, preliminary theories and a search strategy were developed. We searched three databases and screened records with a focus on theoretical and empirical relevance. Insights about contexts, strategies, mechanisms and outcomes were extracted and synthesised into six theories. Five realist interviews were conducted to complement literature-based theorising. The final synthesis included 17 quality-appraised articles describing 15 studies. RESULTS We developed six theories explaining how community engagement or participatory research practices either enhance or hinder the benefits of non-communicable disease research or interventions. Benefit-enhancing mechanisms include community members' agency being realised, a shared understanding of the benefits of health promotion, communities feeling empowered, and community members feeling solidarity and unity. Benefit-hindering mechanisms include community members' agency remaining unrealised and participation being driven by financial motives or reputational expectations. CONCLUSION Our review challenges assumptions about community engagement and participatory research being solely beneficial in the context of non-communicable disease prevention in low- and middle-income countries. We present both helpful and harmful pathways through which health and research outcomes are affected. Our practical recommendations relate to maximising benefits and minimising harm by addressing institutional inflexibility and researcher capabilities, managing expectations on research, promoting solidarity in solving public health challenges and sharing decision-making power.
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Affiliation(s)
- Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Edna Bosire
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Deborah Nyirenda
- Community Engagement & Bioethics, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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Lawless MT, Archibald MM, Ambagtsheer RC, Pinero de Plaza MA, Kitson AL. My Wellbeing Journal: Development of a communication and goal-setting tool to improve care for older adults with chronic conditions and multimorbidity. Health Expect 2024; 27:e13890. [PMID: 37830439 PMCID: PMC10726145 DOI: 10.1111/hex.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Chronic conditions and multimorbidity, the presence of two or more chronic conditions, are increasingly common in older adults. Effective management of chronic conditions and multimorbidity in older adults requires a collaborative and person-centred approach that considers the individual's goals, preferences and priorities. However, ensuring high-quality personalised care for older adults with multimorbidity can be challenging due to the complexity of their care needs, limited time and a lack of patient preparation to discuss their personal goals and preferences with their healthcare team. OBJECTIVE To codesign a communication and goal-setting tool, My Wellbeing Journal, to support personalised care planning for older adults with chronic conditions and multimorbidity. DESIGN We drew on an experience-based codesign approach to develop My Wellbeing Journal. This article reports on the final end-user feedback, which was collected via an online survey with older adults and their carers. SETTING AND PARTICIPANTS Older adults with chronic conditions, multimorbidity and informal carers living in Australia. Personalised care planning was considered in the context of primary care. RESULTS A total of 88 participants completed the online survey. The survey focused on participants' feedback on the tool in terms of effectiveness, efficiency, satisfaction and errors encountered. This feedback resulted in modifications to My Wellbeing Journal, which can be used during clinical encounters to facilitate communication, goal setting and progress tracking. DISCUSSION AND CONCLUSIONS Clinicians and carers can use the tool to guide discussions with older adults about their care planning and help them set realistic goals that are meaningful to them. The findings of this study could be used to inform the development of recommendations for healthcare providers to implement person-centred, goal-oriented care for older adults with chronic conditions and multimorbidity. PATIENT OR PUBLIC CONTRIBUTION Older adults living with chronic conditions and multimorbidity and their carers have contributed to the development of a tool that has the potential to significantly enhance the experience of personalised care planning. Their direct involvement as collaborators has ensured that the tool is optimised to meet the standards of effectiveness and usability.
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Affiliation(s)
- Michael T. Lawless
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Mandy M. Archibald
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Helen Glass Centre for NursingCollege of NursingWinnipegManitobaCanada
| | | | | | - Alison L. Kitson
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
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Thomson LJM, Chatterjee HJ. Barriers and enablers of integrated care in the UK: a rapid evidence review of review articles and grey literature 2018-2022. Front Public Health 2024; 11:1286479. [PMID: 38239795 PMCID: PMC10794528 DOI: 10.3389/fpubh.2023.1286479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Integrated care refers to person-centered and coordinated, health and social care, and community services. Integrated care systems are partnerships of organizations that deliver health and care services which were placed on a statutory footing in England, April 2022. Due to the need for fast, accessible, and relevant evidence, a rapid review was conducted according to World Health Organization methods to determine barriers and enablers of integrated care across the United Kingdom, 2018-2022. Nine databases were searched for review articles reporting evaluation of integrated care interventions involving medical (clinical and diagnostic) and nonmedical (public health services and community-based or social care/person-centred care) approaches, quality checked with the Critical Appraisal Skills Program qualitative checklist. OpenGrey and hand searches were used to identify grey literature, quality checked with the Authority, Accuracy, Coverage, Objectivity, Date, and Significance checklist. Thirty-four reviews and 21 grey literature reports fitted inclusion criteria of adult physical/mental health outcomes/multiple morbidities. Thematic analysis revealed six themes (collaborative approach; costs; evidence and evaluation; integration of care; professional roles; service user factors) with 20 subthemes including key barriers (cost effectiveness; effectiveness of integrated care; evaluation methods; focus of evidence; future research; impact of integration) and enablers (accessing care; collaboration and partnership; concept of integration; inter-professional relationships; person-centered ethos). Findings indicated a paucity of robust research to evaluate such interventions and lack of standardized methodology to assess cost effectiveness, although there is growing interest in co-production that has engendered information sharing and reduced duplication, and inter-professional collaborations that have bridged task-related gaps and overlaps. The importance of identifying elements of integrated care associated with successful outcomes and determining sustainability of interventions meeting joined-up care and preventive population health objectives was highlighted.
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Affiliation(s)
- Linda J. M. Thomson
- Department of Biosciences and Arts & Sciences, University College London, London, United Kingdom
| | - Helen J. Chatterjee
- Department of Biosciences and Arts & Sciences, University College London, London, United Kingdom
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van Erp RAL, de Rooij SE, Wymenga ANM, Zeegers AVCME, van der Palen J. Feasibility study of the Digital Patient Benefit Assessment Scale (P-BAS): A Digital Tool to Assess Individual Patient Goals. Gerontol Geriatr Med 2024; 10:23337214241230159. [PMID: 38328389 PMCID: PMC10848793 DOI: 10.1177/23337214241230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
The study objective was to assess the feasibility of the Patient Benefit Assessment Scale (P-BAS), a digital tool designed to enable older outpatients (≥70 years) to elucidate at home their individual goals regarding their current medical issue. Several digital tools are developed to assist older people in identifying their goals, thereby facilitating the process of shared decision making. However, studies on the feasibility of these digital tools, especially in older patients, are limited. Data were collected from 36 older patients. The study comprised three stages. In stage I and II, cognitive interviews were conducted to strengthen the feasibility of the P-BAS. In stage III, 80% of the patients completed the P-BAS independently at home. The cognitive interviews provided insight into patients' interpretation and individual understanding of the digital visual P-BAS and associated opportunities for improvement, which were subsequently implemented. One conclusion is that the digital visual P-BAS might be of added value for patients and contributes to the process of shared decision making, assuring that the goals of the patient will be into account in treatment options. Findings are useful for researchers interested in technological tools that contribute to shared decision making.
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Affiliation(s)
- Rozemarijn A L van Erp
- University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Enschede, The Netherlands
| | - Sophia E de Rooij
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
| | | | | | - Job van der Palen
- University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Enschede, The Netherlands
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Carbone S, Berta W, Law S, Kuluski K. Long-term care transitions during a global pandemic: Planning and decision-making of residents, care partners, and health professionals in Ontario, Canada. PLoS One 2023; 18:e0295865. [PMID: 38100397 PMCID: PMC10723734 DOI: 10.1371/journal.pone.0295865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
The COVID-19 pandemic appears to have shifted the care trajectories of many residents and care partners in Ontario who considered leaving LTC to live in the community for a portion or the duration of the pandemic. This type of care transition-from LTC to home care-was highly uncommon prior to the pandemic, therefore we know relatively little about the planning and decision-making involved. The aim of this study was to describe who was involved in LTC to home care transitions in Ontario during the COVID-19 pandemic, to what extent, and the factors that guided their decision-making. A qualitative description study involving semi-structured interviews with 32 residents, care partners and health professionals was conducted. Transition decisions were largely made by care partners, with varied input from residents or health professionals. Stakeholders considered seven factors, previously identified in a scoping review, when making their transition decisions: (a) institutional priorities and requirements; (b) resources; (c) knowledge; (d) risk; (e) group structure and dynamic; (f) health and support needs; and (g) personality preferences and beliefs. Participants' emotional responses to the pandemic also influenced the perceived need to pursue a care transition. The findings of this research provide insights towards the planning required to support LTC to home care transitions, and the many challenges that arise during decision-making.
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Affiliation(s)
- Sarah Carbone
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Law
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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Hempel S, Bolshakova M, Hochman M, Jimenez E, Thompson G, Motala A, Ganz DA, Gabrielian S, Edwards S, Zenner J, Dennis B, Chang E. Caring for high-need patients. BMC Health Serv Res 2023; 23:1289. [PMID: 37996845 PMCID: PMC10668484 DOI: 10.1186/s12913-023-10236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE We aimed to explore the construct of "high need" and identify common need domains among high-need patients, their care professionals, and healthcare organizations; and to describe the interventions that health care systems use to address these needs, including exploring the potential unintended consequences of interventions. METHODS We conducted a modified Delphi panel informed by an environmental scan. Expert stakeholders included patients, interdisciplinary healthcare practitioners (physicians, social workers, peer navigators), implementation scientists, and policy makers. The environmental scan used a rapid literature review and semi-structured interviews with key informants who provide healthcare for high-need patients. We convened a day-long virtual panel meeting, preceded and followed by online surveys to establish consensus. RESULTS The environmental scan identified 46 systematic reviews on high-need patients, 19 empirical studies documenting needs, 14 intervention taxonomies, and 9 studies providing construct validity for the concept "high need." Panelists explored the construct and terminology and established that individual patients' needs are unique, but areas of commonality exist across all high-need patients. Panelists agreed on 11 domains describing patient (e.g., social circumstances), 5 care professional (e.g., communication), and 8 organizational (e.g., staffing arrangements) needs. Panelists developed a taxonomy of interventions with 15 categories (e.g., care navigation, care coordination, identification and monitoring) directed at patients, care professionals, or the organization. The project identified potentially unintended consequences of interventions for high-need patients, including high costs incurred for patients, increased time and effort for care professionals, and identification of needs without resources to respond appropriately. CONCLUSIONS Care for high-need patients requires a thoughtful approach; differentiating need domains provides multiple entry points for interventions directed at patients, care professionals, and organizations. Implementation efforts should consider outlined intended and unintended downstream effects on patients, care professionals, and organizations.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA.
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Michael Hochman
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Gina Thompson
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - David A Ganz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | | | - James Zenner
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | - Ben Dennis
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Evelyn Chang
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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17
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Hinckley J, Jayes M. Person-centered care for people with aphasia: tools for shared decision-making. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1236534. [PMID: 37928752 PMCID: PMC10623353 DOI: 10.3389/fresc.2023.1236534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Shared decision-making is a fundamental aspect of person-centered care, and can and should be part of many different aspects of the rehabilitation process. Communication disabilities like aphasia, which affects people's ability to use and understand spoken and written language, can make shared decision-making especially challenging to the resources and skills of rehabilitation practitioners. The purpose of this narrative review is to provide a comprehensive description of tools that can support successful shared decision-making with people with aphasia in the rehabilitation environment. These tools and strategies are appropriate for use by physicians, nurses, social workers, physical therapists (also referred to as physiotherapists), occupational therapists, and other service or care providers. The important role of speech-language pathologists as consultants is also described. Case scenarios throughout the paper illustrate the application of recommended tools and strategies along with best practices.
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Affiliation(s)
- Jacqueline Hinckley
- Department of Speech/Language Pathology, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Mark Jayes
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
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18
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Christoffersen NB, Nilou FE, Thilsing T, Larsen LB, Østergaard JN, Broholm-Jørgensen M. Exploring targeted preventive health check interventions - a realist synthesis. BMC Public Health 2023; 23:1928. [PMID: 37798691 PMCID: PMC10557298 DOI: 10.1186/s12889-023-16861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Preventive health checks are assumed to reduce the risk of the development of cardio-metabolic disease in the long term. Although no solid evidence of effect is shown on health checks targeting the general population, studies suggest positive effects if health checks target people or groups identified at risk of disease. The aim of this study is to explore why and how targeted preventive health checks work, for whom they work, and under which circumstances they can be expected to work. METHODS The study is designed as a realist synthesis that consists of four phases, each including collection and analysis of empirical data: 1) Literature search of systematic reviews and meta-analysis, 2) Interviews with key-stakeholders, 3) Literature search of qualitative studies and grey literature, and 4) Workshops with key stakeholders and end-users. Through the iterative analysis we identified the interrelationship between contexts, mechanisms, and outcomes to develop a program theory encompassing hypotheses about targeted preventive health checks. RESULTS Based on an iterative analysis of the data material, we developed a final program theory consisting of seven themes; Target group; Recruitment and participation; The encounter between professional and participants; Follow-up activities; Implementation and operation; Shared understanding of the intervention; and Unintended side effects. Overall, the data material showed that targeted preventive health checks need to be accessible, recognizable, and relevant for the participants' everyday lives as well as meaningful to the professionals involved. The results showed that identifying a target group, that both benefit from attending and have the resources to participate pose a challenge for targeted preventive health check interventions. This challenge illustrates the importance of designing the recruitment and intervention activities according to the target groups particular life situation. CONCLUSION The results indicate that a one-size-fits-all model of targeted preventive health checks should be abandoned, and that intervention activities and implementation depend on for whom and under which circumstances the intervention is initiated. Based on the results we suggest that future initiatives conduct thorough needs assessment as the basis for decisions about where and how the preventive health checks are implemented.
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Affiliation(s)
- Nanna Bjørnbak Christoffersen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Freja Ekstrøm Nilou
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Thilsing
- Research Unit of General Practice, University of Southern, Odense, Denmark
| | - Lars Bruun Larsen
- Research Unit of General Practice, University of Southern, Odense, Denmark
- Steno Diabetes Center Zealand, Holbæk, Denmark
| | | | - Marie Broholm-Jørgensen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Elf M, Slaug B, Ytterberg C, Heylighen A, Kylén M. Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:172-186. [PMID: 37287249 PMCID: PMC10621028 DOI: 10.1177/19375867231178313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke. BACKGROUND Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse. METHODS In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis. RESULTS Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings. CONCLUSIONS Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.
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Affiliation(s)
- Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Björn Slaug
- Department of Health Sciences, Lund University, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Heylighen
- Research[x]Design, Department of Architecture, KU Leuven, Belgium
| | - Maya Kylén
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Health Sciences, Lund University, Sweden
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Yakubu RA, Coleman A, Ainyette A, Katyayan A, Enard KR. Shared Decision-Making and Emergency Department Use Among People With High Blood Pressure. Prev Chronic Dis 2023; 20:E82. [PMID: 37733952 PMCID: PMC10516202 DOI: 10.5888/pcd20.230086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Forty-seven percent of all adults in the US have a diagnosis of high blood pressure. Among all US emergency department (ED) users, an estimated 45% have high blood pressure. The success of high blood pressure interventions in reducing ED visits is partially predicated on patients' adherence to treatment plans. One method for promoting adherence to treatment plans is shared decision-making between patients and medical providers. METHODS We conducted a cross-sectional observational study using 2015-2019 Medical Expenditure Panel Survey data. We used studies on shared decision-making as a guide to create a predictor variable for shared decision-making. We determined covariates according to the Andersen Behavioral Model of Health Services Use. ED use was the outcome variable. We used cross tabulation to compare covariates of ED use and multivariable logistical regression to assess the association between shared decision-making and ED use. Our sample size was 30,407 adults. RESULTS Less than half (39.3%) of respondents reported a high level of shared decision-making; 23.3% had 1 or more ED visits. In the unadjusted model, respondents who reported a high level of shared decision-making were 20% less likely than those with a low level of shared decision-making to report 1 or more ED visits (odds ratio [OR], 0.80; 95% CI, 0.75-0.86; P <.001). After adjusting for covariates, a high level of shared decision-making was still associated with lower odds of ED use (OR, 0.86; 95% CI, 0.76-0.97; P = .01). CONCLUSION Shared decision-making may be an effective method for reducing ED use among patients with high blood pressure.
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Affiliation(s)
- R Aver Yakubu
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
- Saint Louis University, Department of Health Management and Policy, 3545 Lafayette Ave, St Louis, MO 63104
| | - Alyssa Coleman
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Alina Ainyette
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Anisha Katyayan
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Kimberly R Enard
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
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Saeed F, Dahl S, Horowitz RK, Duberstein PR, Epstein RM, Fiscella KA, Allen RJ. Development and Acceptability of a Kidney Therapy Decision Aid for Patients Aged 75 Years and Older: A Design-Based Research Involving Patients, Caregivers, and a Multidisciplinary Team. Kidney Med 2023; 5:100671. [PMID: 37492114 PMCID: PMC10363565 DOI: 10.1016/j.xkme.2023.100671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Rationale & Objective Many older adults prefer quality of life over longevity, and some prefer conservative kidney management (CKM) over dialysis. There is a lack of patient-decision aids for adults aged 75 years or older facing kidney therapy decisions, which not only include information on dialysis and CKM but also encourage end-of-life planning. We iteratively developed a paper-based patient-decision aid for older people with low literacy and conducted surveys to assess its acceptability. Study Design Design-based research. Setting and Participants Informed by design-based research principles and theory of behavioral activation, a multidisciplinary team of experts created a first version of the patient-decision aid containing 2 components: (1) educational material about kidney therapy options such as CKM, and (2) a question prompt list relevant to kidney therapy and end-of-life decision making. On the basis of the acceptability input of patients and caregivers, separate qualitative interviews of 35 people receiving maintenance dialysis, and with the independent feedback of educated layperson, we further modified the patient-decision aid to create a second version. Analytical Approach We used descriptive statistics to present the results of acceptability surveys and thematic content analyses for patients' qualitative interviews. Results The mean age of patients (n=21) who tested the patient-decision aid was 80 years and the mean age of caregivers (n=9) was 70 years. All respondents held positive views about the educational component and would recommend the educational component to others (100% patients and caregivers). Most of the patients reported that the question prompt list helped them put concerns into words (80% patients and 88% caregivers) and would recommend the question prompt list to others (95% patients and 100% caregivers). Limitations Single-center study. Conclusions Both components of the patient-decision aid received high acceptability ratings. We plan to launch a larger effectiveness study to test the outcomes of a decision-supporting intervention combining the patient-decision aid with palliative care-based decision coaching.
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Affiliation(s)
- Fahad Saeed
- Department of Medicine, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, NY
- Department of Medicine, Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Spencer Dahl
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Robert K. Horowitz
- Department of Medicine, Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Paul R. Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ
| | - Ronald M. Epstein
- Department of Medicine, Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Kevin A. Fiscella
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Rebecca J. Allen
- Mount St. Joseph University, School of Behavioral and Natural Sciences, Cincinnati, OH
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Tsunawaki S, Abe M, DeJonckheere M, Cigolle CT, Philips KK, Rubinstein EB, Matsuda M, Fetters MD, Inoue M. Primary care physicians' perspectives and challenges on managing multimorbidity for patients with dementia: a Japan-Michigan qualitative comparative study. BMC PRIMARY CARE 2023; 24:132. [PMID: 37370035 PMCID: PMC10294331 DOI: 10.1186/s12875-023-02088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Multimorbidity management can be extremely challenging in patients with dementia. This study aimed to elucidate the approaches of primary care physicians in Japan and the United States (US) in managing multimorbidity for patients with dementia and discuss the challenges involved. METHODS This qualitative study was conducted through one-on-one semi-structured interviews among primary care physicians, 24 each from Japan and Michigan, US. Thematic and content analyses were performed to explore similarities and differences among each country's data. RESULTS Primary care physicians in Japan and Michigan applied a relaxed adherence to the guidelines for patients' chronic conditions. Common challenges were the suboptimal consultation time, the insufficient number or ability of care-coordinating professionals, patients' conditions such as difficulties with self-management, living alone, behavioral issues, and refusal of care support. Unique challenges in Japan were free-access medical systems and not being sure about the patients' will in end-of-life care. In Michigan, physicians faced challenges in distance and lack of transportation between clinics and patients' homes and in cases where patients lacked the financial ability to acquire good care. CONCLUSIONS To improve the quality of care for patients with multimorbidity and dementia, physicians would benefit from optimal time and compensation allocated for this patient group, guidelines for chronic conditions to include information regarding changing priority for older adults with dementia, and the close collaboration of medical and social care and community resources with support of skilled care-coordinating professionals.
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Affiliation(s)
- Shinji Tsunawaki
- Omaezaki Family Medicine Center, Omaezaki, Shizuoka, Japan
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan
| | - Michiko Abe
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | | | - Christine T Cigolle
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System (VAAAHS) Geriatric Research, Ann Arbor, MI, USA
| | - Kristin K Philips
- Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System (VAAAHS) Geriatric Research, Ann Arbor, MI, USA
| | - Ellen B Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, ND, USA
| | - Masakazu Matsuda
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan
- Kikugawa Family Medicine Center, Kikugawa, Shizuoka, Japan
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- The School of Health Humanities, Peking University Health Science Center, Beijing, China
| | - Machiko Inoue
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan.
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
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Martínez-Angulo P, Rich-Ruiz M, Ventura-Puertos PE, López-Quero S. Integrating shared decision-making, expressing preferences and active participation of older adults in primary care nursing: a systematic review of qualitative studies and qualitative meta-synthesis. BMJ Open 2023; 13:e071549. [PMID: 37344120 DOI: 10.1136/bmjopen-2022-071549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVES To systematically synthesise the results of primary qualitative studies on how community-dwelling older adults experience shared decision-making processes, express preferences and actively participate in care. DESIGN Systematic review of qualitative studies and qualitative meta-synthesis. METHODS We focused on studies about community-dwelling participants aged ≥65 undergoing a health-disease process circumscribed to a primary healthcare setting, and the central theme should focus on either shared decision-making, expressing preferences or patient participation. We searched the following databases: MEDLINE, CINAHL, Web of Science, Scopus and PsycINFO (time publication frame 2012-2022). We excluded studies in those cases where the qualitative results were not analysed or unrelated to the phenomenon addressed, phenomena were not clear enough to be included or the setting did not occur in the community. RESULTS A total of 12 studies were included in this meta-synthesis. We appraised the quality of the selected studies through Critical Appraisal Skills Programme (CASP) Checklist. The metasummary comprised the frequency and intensity of qualitative patterns across the included studies. The meta-synthesis revealed four influential elements in their interaction: recognising personal qualities, facing professional characteristics, experiences of discrimination and a double-edged context. CONCLUSIONS The phenomena studied were influenced by how older people approached their role in their binomial relationship with healthcare professionals. Those with a reinforced self-concept were better aware of health-disease-related situations regarding shared decision-making and the importance of being communicatively assertive. Professional characteristics were also crucial in how older people modulated their acting ability through their personality, communication skills and the approach healthcare professionals used towards older adults. Situations of discrimination generated through an imbalance of power inhibited the expression of preferences and hindered the active participation of older people. The context surrounding the participants influenced all these situations, key in tipping the balance between a therapeutic and a harmful side. PROSPERO REGISTRATION NUMBER CRD42022363515.
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Affiliation(s)
- Pablo Martínez-Angulo
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Córdoba, Andalucía, Spain
- Interdisciplinary Research Group in Discourse Analysis (HUM380), University of Córdoba (UCO), Córdoba, Andalucía, Spain
| | - Manuel Rich-Ruiz
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Córdoba, Andalucía, Spain
- Nursing and Healthcare Research Unit (Investén-isciii), Instituto de Salud Carlos III, Madrid, Spain
- Ciber Fragility and Healthy Aging (CIBERFES), Madrid, Spain
| | - Pedro E Ventura-Puertos
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Córdoba, Andalucía, Spain
- Interdisciplinary Research Group in Discourse Analysis (HUM380), University of Córdoba (UCO), Córdoba, Andalucía, Spain
| | - Salvador López-Quero
- Interdisciplinary Research Group in Discourse Analysis (HUM380), University of Córdoba (UCO), Córdoba, Andalucía, Spain
- Department of Language Sciences, Faculty of Philosophy and Letters, University of Córdoba (UCO), Córdoba, Andalucía, Spain
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Jones D, Ali OM, Honey S, Surr C, Scott S, De Wit N, Neal RD. Patients' views on the decision to investigate cancer symptoms in older adults: a qualitative interview study in primary care. Br J Gen Pract 2023:BJGP.2022.0622. [PMID: 37365009 PMCID: PMC10327112 DOI: 10.3399/bjgp.2022.0622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Accepted: 04/04/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Cancer is predominantly a disease of older adults. To date there has been little research on the experiences of older adults or their views on the diagnostic pathway. AIM To gain an improved understanding of the views and experiences of older adults on all aspects of cancer investigation. DESIGN AND SETTING This was a qualitative study using semi-structured interviews with patients aged ≥70 years. Patients were recruited from primary care in West Yorkshire, UK. METHOD Data were analysed using a thematic framework analysis. RESULTS The themes identified in participants' accounts included the patients' process of decision making, the value of having a diagnosis, the patients' experience of cancer investigations, and the impact of the COVID-19 pandemic on the diagnostic pathway. Older adults in this study indicated a clear preference for having clarity on the cause of symptoms and the diagnosis, even in the face of unpleasant investigations. Patients suggested they wanted to be involved in the decision process. CONCLUSION Older adults who present to primary care with symptoms suggestive of cancer may accept diagnostic testing solely for the benefit of knowing the diagnosis. There was a clear patient preference that referrals and investigations for cancer symptoms should not be deferred or delayed based on age or subjective assessments of frailty. Shared decision making and being involved in the decision-making process are important to patients, regardless of age.
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Affiliation(s)
- Daniel Jones
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Omer M Ali
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stephanie Honey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Suzanne Scott
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Niek De Wit
- Julius Center for Health Sciences and Primary Care, and professor of general practice, University Medical Center, Utrecht, the Netherlands
| | - Richard D Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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O Donnell D, Davies C, Christophers L, Ní Shé É, Donnelly S, Kroll T. An examination of relational dynamics of power in the context of supported (assisted) decision-making with older people and those with disabilities in an acute healthcare setting. Health Expect 2023; 26:1339-1348. [PMID: 36919231 PMCID: PMC10154890 DOI: 10.1111/hex.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 01/09/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Supported (assisted) healthcare decision-making (ADM) focuses attention on how people with disabilities, including cognitive impairments, can be best supported to make decisions about their health and social care on an equitable basis with others. Meaningful implementation of legal frameworks for ADM challenges long-held presumptions about who has access to valued decision-making resources, influence and power within a particular socio-cultural setting. This study aims to explore the relational power dynamics around ADM with older people in acute care settings. METHODS This study adopts a critical hermeneutic approach to qualitatively explore the lived experience of ADM from the perspectives of Health and Social Care Professionals (N = 26). This is supported by an exploration of the experiences of older people (N = 4), older people with a diagnosis of dementia (N = 4) and family carers (N = 5). RESULTS We present three themes of data analysis that represent three spaces where the relational aspects of power in ADM are manifested. The first space, centralising decision-making power within multidisciplinary teams identified the privileging of physicians in traditional hierarchical leadership models that may lead to the implicit exclusion of family carers and some Health and Social Care Professionals in the ADM process. Privileging cognitive and communication competence identified a tendency to attribute decision-making autonomy to those with cognitive and communication competency. The final space, balancing the duty of care and individual autonomy, recognises acute care settings as typically risk-averse cultures that limit autonomy for decisions that carry risk, especially for those with cognitive impairment. CONCLUSION Findings indicate the need to address cultural sources of power operating through social norms premised on ageist and ableist ideologies. It is necessary to challenge institutional barriers to meaningful ADM including positional power that is associated with hierarchies of influence and protectionism. Finally, meaningful ADM requires resistance to the disempowerment created by structural, economic and social circumstances which limit choices for decision-making. PATIENT OR PUBLIC CONTRIBUTION A public and patient involvement panel of older people were consulted in the development of the grant application (HRB: APA-2016-1878). Representatives from Alzheimer's Society Ireland and Family Carers Ireland were steering committee members guiding design and strategy.
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Affiliation(s)
- Deirdre O Donnell
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Carmel Davies
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lauren Christophers
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
| | - Thilo Kroll
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Bernabeu-Wittel M, Para O, Voicehovska J, Gómez-Huelgas R, Václavík J, Battegay E, Holecki M, van Munster BC. Competences of internal medicine specialists for the management of patients with multimorbidity. EFIM multimorbidity working group position paper. Eur J Intern Med 2023; 109:97-106. [PMID: 36653235 DOI: 10.1016/j.ejim.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
Patients with multimorbidity increasingly impact healthcare systems, both in primary care and in hospitals. This is particularly true in Internal Medicine. This population associates with higher mortality rates, polypharmacy, hospital readmissions, post-discharge syndrome, anxiety, depression, accelerated age-related functional decline, and development of geriatric syndromes, amongst others. Internists and Hospitalists, in one of their roles as Generalists, are increasingly asked to attend to these patients, both in their own Departments as well as in surgical areas. The management of polypathology and multimorbidity, however, is often complex, and requires specific clinical skills and corresponding experience. In addition, patients' needs, health-care environment, and routines have changed, so emerging and re-emerging specific competences and approaches are required to offer the best coordinated, continuous, and comprehensive integrated care to these populations, to achieve optimal health outcomes and satisfaction of patients, their relatives, and staff. This position paper proposes a set of emerging and re-emerging competences for internal medicine specialists, which are needed to optimally address multimorbidity now and in the future.
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Affiliation(s)
- M Bernabeu-Wittel
- Department of Medicine, Internal Medicine Department. Hospital Universitario Virgen del Rocío, University of Sevilla, Spain
| | - O Para
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - J Voicehovska
- Internal Diseases Department, Nephrology and Renal replacement therapy clinics, Riga Stradins University, Riga East University hospital, Riga, Latvia
| | - R Gómez-Huelgas
- Internal Medicine Department. Department of Medicine, Hospital Universitario Regional de Málaga, University of Málaga, Spain
| | - J Václavík
- Department of Internal Medicine and Cardiology, University Hospital Ostrava and Ostrava University Faculty of Medicine, Ostrava, Czech Republic
| | - E Battegay
- International Center for Multimorbidity and Complexity (ICMC), University of Zurich, Zurich, University Hospital Basel (Department of Psychosomatic Medicine) and Merian Iselin Klinik Basel. Switzerland
| | - M Holecki
- Department of Internal, Autoimmune and Metabolic Diseases. Medical University of Silesia, Katowice. Poland
| | - B C van Munster
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Vogel A, Guinemer C, Fürstenau D. Patients' and healthcare professionals' perceived facilitators and barriers for shared decision-making for frail and elderly patients in perioperative care: a scoping review. BMC Health Serv Res 2023; 23:197. [PMID: 36829131 PMCID: PMC9960423 DOI: 10.1186/s12913-023-09120-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/27/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) in perioperative care, is an organizational approach to instituting sharing of information and decision-making around surgery. It aims at enabling patient autonomy and patient-centered care. Frail and elderly patients suffering from multiple health conditions and increased surgical vulnerability might particularly benefit from SDM. However, little is known about the facilitators and barriers to implementing SDM in perioperative care for the specific needs of frail and elderly patients. Our objective is twofold: First, we aim at collecting, analyzing, categorizing, and communicating facilitators and barriers. Second, we aim at collecting and mapping conceptual approaches and methods employed in determining and analyzing these facilitators and barriers. METHODS The search strategy focused on peer-reviewed studies. We employed a taxonomy which is based on the SPIDER framework and added the items general article information, stakeholder, barriers/facilitators, category, subcategory, and setting/contextual information. This taxonomy is based on preceding reviews. The scoping review is reported under the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews. Based on the databases MEDLINE, Embase, CINAHL, and Web of Science, we screened 984 articles, identified, and reviewed 13 original studies. RESULTS Within this review, two primary facilitators concerning patients' willingness to participate in SDM emerged: Patients want to be informed on their medical condition and procedures. Patients prefer sharing decisions with healthcare professionals, compared to decision-making solely by patients or decision-making solely by healthcare professionals. Communication issues and asymmetric power relationships between patients and clinical healthcare professionals are barriers to SDM. Regarding the methodological approaches, the evaluation of the conceptual approaches demonstrates that the selected articles lack employing a distinct theoretical framework. Second, the selected studies mainly used surveys and interviews, observational studies, like ethnographic or video-based studies are absent. CONCLUSION Diverging findings perceived by patients or clinical healthcare professionals were identified. These imply that SDM research related to elderly and frail patients should become more encompassing by employing research that incorporates theory-based qualitative analysis, and observational studies of SDM consultations for understanding practices by patients and clinical healthcare professionals. Observational studies are particularly relevant as these were not conducted. TRIAL REGISTRATION https://osf.io/8fjnb/.
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Affiliation(s)
- Amyn Vogel
- School of Business & Economics, Department of Information Systems, Freie Universität Berlin, Berlin, Germany.
| | - Camille Guinemer
- grid.6363.00000 0001 2218 4662Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Fürstenau
- grid.6363.00000 0001 2218 4662Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.32190.390000 0004 0620 5453Department of Business IT, IT University of Copenhagen, Copenhagen, Denmark
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Rowland T, Lindberg-Larsen M, Santy-Tomlinson J, Jensen CM. A qualitative study of patients' experiences before, during and after surgical treatment for periprosthetic knee joint infection; "I assumed it had to be like that … ". Int J Orthop Trauma Nurs 2023; 48:100992. [PMID: 36630741 DOI: 10.1016/j.ijotn.2022.100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/05/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) of the knee is associated with extended hospital stay, high doses of antibiotics, lengthy rehabilitation, and pain. Standard treatment is a two-stage procedure comprising two surgeries and two hospitalizations. To facilitate exploration of patients' perspectives, the qualitative study presented here was an adjunct to a Danish randomized controlled trial comparing one-stage and two-stage revision surgery. AIM To explore patient experiences, before, during and after hospitalization and surgical treatment with one- or two-stage revision for PJI of the knee. MATERIAL AND METHODS Qualitative, semi-structured telephone interviews were conducted with 10 individuals who had undergone either one- or two-stage revision because of PJI. Thematic analysis was employed. RESULTS The essence of the findings was that the infection was a transition point in a possible life-changing illness. The three themes representing this comprised: 1) physical, 2) psychological, and 3) social implications. Each theme is further illuminated with subthemes. CONCLUSIONS Infection is a transition point in a possible life changing illness. Late diagnosis and delayed treatment are major issues. Individuals suffer from pain, weight loss, fatigue, and reduced mobility as well as dependency on family members, leading to psychological challenges including depression. IMPLICATIONS FOR CLINICAL PRACTICE Patients with PJI of the knee could be better informed, educated and involved before and during treatment. Information is needed not only about the physical consequences, but also the psychological and social consequences. More patient involvement and inter-professional and care sector coordination is important when caring for patients with PJI.
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Affiliation(s)
- Tina Rowland
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | - Martin Lindberg-Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Julie Santy-Tomlinson
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | - Charlotte Myhre Jensen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Yip O, Dhaini S, Esser J, Siqeca F, Mendieta MJ, Huber E, Zeller A, De Geest S, Deschodt M, Zúñiga F, Zullig LL, King HA, Urfer P, Vounatsou P, Obas K, Briel M, Schwenkglenks M, Quinto C, Blozik E. Health and social care of home-dwelling frail older adults in Switzerland: a mixed methods study. BMC Geriatr 2022; 22:857. [PMID: 36376806 PMCID: PMC9663289 DOI: 10.1186/s12877-022-03552-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Home-dwelling frail older adults are often faced with multimorbidity and complex care needs, requiring health and social care systems that support frail older adults to age in place. The objective of this paper was to investigate the types of formal health and social care as well as informal care and social support used by home-dwelling frail older adults; whether they perceive their support as sufficient; and their experience with and preferences for care and support. Methods Using an explanatory sequential mixed methods design, we first conducted a secondary analysis of a subset of cross-sectional data from the ImplemeNtation of a community-baSed care Program for home dwelling senIoR citizEns (INSPIRE) population survey using descriptive analysis. Subsequently, we analyzed existing data from interviews in the parent study to help explain the survey results using applied thematic analysis. Results were organized according to adapted domains and concepts of the SELFIE framework and integrated via a joint display table. Results Of the parent population survey respondents, 2314 older adults indicating frailty were included in the quantitative arm of this study. Interview data was included from 7 older adults who indicated frailty. Support from health and social, formal and informal caregivers is diverse and anticipated to increase (e.g., for ‘care and assistance at home’ and ‘meal services’). Informal caregivers fulfilled various roles and while some older adults strongly relied on them for support, others feared burdening them. Most participants (93.5%) perceived their overall support to meet their needs; however, findings suggest areas (e.g., assessment of overall needs) which merit attention to optimize future care. Conclusions Given the anticipated demand for future care and support, we recommend efforts to prevent fragmentation between health and social as well as formal and informal care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03552-z.
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Hsiao CY, Wu JC, Lin PC, Yang PY, Liao F, Guo SL, Hou WH. Effectiveness of interprofessional shared decision-making training: A mixed-method study. PATIENT EDUCATION AND COUNSELING 2022; 105:3287-3297. [PMID: 35927112 DOI: 10.1016/j.pec.2022.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study evaluated the learning effects and examined the participants' perceptions of an interprofessional shared decision-making (IP-SDM) training program. METHODS This mixed-method study used a quasi-experimental pretest-posttest design in the quantitative phase and semi-structured interviews in the qualitative phase. The 6-week curriculum design, based on Kolb's experiential learning cycle, consisted of two simulated objective structured clinical examinations with standardized patients and blended teaching methods through various course modules. RESULTS A total of 39 multidisciplinary healthcare personnel completed the 6-week training program, and 32 of them participated in qualitative interviews. The IP-SDM training program effectively improved the SDM process competency of the participants from the perspectives of the participants, standardized patients, and clinical teachers. The interviews illustrated how the curriculum design enhanced learning; the effectiveness results indicated improvements in learners' attitude, knowledge, skills, and teamwork. CONCLUSION This IP-SDM training program improved multidisciplinary healthcare personnel's competency, self-efficacy, and intention to engage in IP-SDM. PRACTICE IMPLICATIONS Applying Kolb's experiential learning cycle and blended teaching methods to develop and implement the IP-SDM training program can improve multidisciplinary healthcare personnel's knowledge, attitude, skills, and teamwork in IP-SDM.
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Affiliation(s)
- Chih-Yin Hsiao
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan; Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Pi-Chu Lin
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing & Graduate Institute of Nursing, Asia University, Taichung, Taiwan; Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Pang-Yuan Yang
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Faith Liao
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan; Department of Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Liu Guo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wen-Hsuan Hou
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation & Geriatrics and Gerontology, Taipei Medical University Hospital, Taipei, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Leung AYM, Parial LLB, Szeto SS, Koduah AO. Understanding the role of financial health literacy in midlife and old age: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3921-e3933. [PMID: 36350147 PMCID: PMC10100128 DOI: 10.1111/hsc.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/03/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
As global population ageing persists, understanding older adults' capacity to navigate the financial and healthcare system is essential. This scoping review examines how the concept of financial health literacy (FHL) is described and measured in the existing literature, the factors that may affect it, and its potential outcomes in middle-aged and older adults. The review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) extension guidelines to synthesise the available evidence on this topic. We utilised electronic databases and hand searching to identify relevant literature published between 2010 and 2022. A total of 29 articles were included in this review. The results showed that FHL involved accessing, understanding and utilising financial information for planning/management of healthcare expenses and selecting appropriate health services. However, FHL is not particularly depicted as a concept in the current literature, as most studies investigated health literacy, financial literacy and health insurance literacy as separate domains that were interrelated to one another. No validated measurement tool was developed for FHL. We propose five domains to indicate the concept and measurement of FHL in middle-aged/older adults: money management, management of medical bills, understanding health insurance, deciding on appropriate health services, and planning for long-term care needs. Demographic variables, such as sex (females), advanced age, cognitive impairment, low education and income and racial and ethnic minorities, were found to be related to low FHL. The reviewed studies also showed that FHL was related to several outcomes, including healthcare decision-making, physical health and psychological well-being. Hence, future studies to develop and validate assessment tools of FHL, together with the involvement of vulnerable groups, are imperative to understanding the concept of FHL. This could also facilitate the development of appropriate interventions that could enhance this capacity in the ageing population.
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Affiliation(s)
- Angela Y. M. Leung
- School of NursingThe Hong Kong Polytechnic UniversityHong Kong SARChina
- World Health Organization Collaborating Centre (WHOCC) for Community Health Services, School of NursingThe Hong Kong Polytechnic UniversityHong Kong SARChina
- Research Institute of Smart AgingThe Hong Kong Polytechnic UniversityHong Kong SARChina
| | - Laurence Lloyd B. Parial
- School of NursingThe Hong Kong Polytechnic UniversityHong Kong SARChina
- College of NursingUniversity of the Philippines ManilaManilaPhilippines
| | | | - Adwoa O. Koduah
- School of NursingThe Hong Kong Polytechnic UniversityHong Kong SARChina
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Making shared decisions with older men selecting treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH): a pilot randomized trial. J Patient Rep Outcomes 2022; 6:112. [PMID: 36242683 PMCID: PMC9569273 DOI: 10.1186/s41687-022-00519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Background Making high-quality decisions when selecting treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) requires a shared decision-making approach. However, older people with lower health literacy face barriers. The pilot study aimed to evaluate the feasibility of recruiting participants and evaluate the effectiveness of a multi-level intervention on decision quality for the treatment of LUTS/BPH. Method In this 2-arm, randomized controlled trial, multi-ethnic Asian men aged ≥ 50 years with moderate or severe symptoms (IPSS ≥ 8 and/or QOL ≥ 3) and physicians were recruited at a Singapore public primary care clinic. Men were randomized to either physicians trained in shared decision-making and used a pictorial patient-reported symptom score (Visual Analogue Uroflowmetry Score) during the consultation or to physicians untrained in shared decision-making who did not use the score. Decision quality was measured using SDMQ-9 scores from men and their physicians after the consultation. Results 60 men (intervention [n = 30], control [n = 30]) receiving care from 22 physicians were recruited. Men’s mean age was 70 ± 9 years: 87% were Chinese, 40% had no formal education, and 32% were of lower socioeconomic status. No difference in decision quality from the men’s nor their physicians’ perspectives was noted [for men: mean score = 70.8 (SD 20.3) vs. 59.5 (SD 22.4); adjusted p = 0.352] [for physicians: mean score = 78.1 (SD 14.1) vs. 73.2 (SD 19.8); adjusted p > 0.999]. Conclusion It was feasible to recruit the intended participants. There was no difference in decision quality between men who used shared decision-making and usual care for the treatment of LUTS/BPH. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00519-x.
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Kime N, Wright A, Heaven A, Hawkins R, Smith J, Cundill B, Foy R, Lawton R, Farrin A, Hulme C, Clegg A. Implementing personalised care planning for older people with frailty: a process evaluation of the PROSPER feasibility trial. BMC Geriatr 2022; 22:760. [PMID: 36114521 PMCID: PMC9479257 DOI: 10.1186/s12877-022-03426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Personalised Care Planning (PCP) is a collaborative approach used in the management of chronic conditions. Core components of PCP are shared decision making to achieve joint goal setting and action planning by the clinician and patient. We undertook a process evaluation within the PROSPER feasibility trial to understand how best to implement PCP for older people with frailty in the community. Methods The trial was set in two localities in England. We observed training sessions and intervention delivery at three time points during the 12-week intervention period. We interviewed delivery teams before, during and after the intervention period, as well as primary care staff. We interviewed older people who had received, declined or withdrawn from PCP. We explored training of staff delivering PCP, structures, mechanisms and resources needed for delivery, and influences on uptake. We undertook a framework approach to data analysis. Findings We observed thirteen training sessions and interviewed seven delivery staff, five primary care staff, and twenty older people, including seven who had declined or withdrawn from the intervention. Delivery teams successfully acquired skills and knowledge, but felt underprepared for working with people with lower levels of frailty. Timing of training was critical and ‘top-ups’ were needed. Engagement with primary care staff was tenuous. Older people with lower frailty were unclear of the intervention purpose and benefits, goal setting and action planning. Conclusions PCP has the potential to address the individualised needs of older people with frailty. However, training requires careful tailoring and is ideally on-going. Considerable efforts are required to integrate statutory and voluntary stakeholders, understanding the expectations and contributions of each agency from the outset. In addition, older people with frailty need time and support to adjust to new ways of thinking about their own health now and in the future so they can participate in shared decision making. These key factors will be essential when developing models of care for delivering PCP to support older people with frailty to sustain their independence and quality of life. Trial registration ISRCTN 12,363,970 – 08/11/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03426-4.
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Iyer I, Iyer A, Kanthawar P, Khot UN. Assessment of freely available online videos of cardiac electrophysiological procedures from a shared decision-making perspective. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:189-196. [PMID: 36046431 PMCID: PMC9422056 DOI: 10.1016/j.cvdhj.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Physicians recommend electrophysiological (EP) procedures to patients with arrhythmic risk. This involves shared decision-making (SDM). Patients increasingly search for additional information online. Freely available online videos are an attractive source. Objective We assessed freely available online videos for EP procedures from the perspective of SDM to determine if such videos can be shared with patients for SDM. Methods We searched for freely available online videos related to 6 common EP procedures limited to English language and duration between 1 and 10 minutes using Google and Bing. Data collected included date and source of upload, number of hits, and duration. Videos were assessed systematically for understandability, actionability (PEMAT tool), relatability, teamwork, and mention of risk. Results A total of 78 videos met our inclusion criteria, out of 960 video links. Overall inter-rater agreement was moderate to good. Video upload dates spanned 12 years and number of hits ranged from 87 to 594,000. The majority of videos (63%) were produced by health care systems or academic institutions. For all 78 videos the mean total PEMAT tool score was 48.6%. Thirty-five percent of videos showed a patient engaged in a conversation with the physician or a team member; 41% of videos showed other team members. The potential for complications was mentioned in 10%. Conclusion The majority of online, freely available videos for common EP procedures lack features useful for SDM and may not be helpful for sharing with patients from that perspective. It is possible to create high-quality videos that can facilitate SDM.
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Affiliation(s)
- Indiresha Iyer
- Lerner College of Medicine, Cleveland Clinic Akron General, Akron, Ohio
- Address reprint requests and correspondence: Dr Indiresha Iyer, Lerner College of Medicine, Cleveland Clinic Akron General, 224 West Exchange St, Suite 225, Akron, OH 44307.
| | - Amogh Iyer
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Pooja Kanthawar
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Umesh N. Khot
- Regional Cardiovascular Medicine, HVTI, Cleveland Clinic, Cleveland, Ohio
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Carbone S, Kokorelias KM, Berta W, Law S, Kuluski K. Stakeholder involvement in care transition planning for older adults and the factors guiding their decision-making: a scoping review. BMJ Open 2022; 12:e059446. [PMID: 35697455 PMCID: PMC9196186 DOI: 10.1136/bmjopen-2021-059446] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To synthesise the existing literature on care transition planning from the perspectives of older adults, caregivers and health professionals and to identify the factors that may influence these stakeholders' transition decision-making processes. DESIGN A scoping review guided by Arksey and O'Malley's six-step framework. A comprehensive search strategy was conducted on 7 January 2021 to identify articles in five databases (MEDLINE, Embase, CINAHL Plus, PsycINFO and AgeLine). Records were included when they described care transition planning in an institutional setting from the perspectives of the care triad (older adults, caregivers and health professionals). No date or study design restrictions were imposed. SETTING This review explored care transitions involving older adults from an institutional care setting to any other institutional or non-institutional care setting. Institutional care settings include communal facilities where individuals dwell for short or extended periods of time and have access to healthcare services. PARTICIPANTS Older adults (aged 65 or older), caregivers and health professionals. RESULTS 39 records were included. Stakeholder involvement in transition planning varied across the studies. Transition decisions were largely made by health professionals, with limited or unclear involvement from older adults and caregivers. Seven factors appeared to guide transition planning across the stakeholder groups: (a) institutional priorities and requirements; (b) resources; (c) knowledge; (d) risk; (e) group structure and dynamic; (f) health and support needs; and (g) personality preferences and beliefs. Factors were described at microlevels, mesolevels and macrolevels. CONCLUSIONS This review explored stakeholder involvement in transition planning and identified seven factors that appear to influence transition decision-making. These factors may be useful in advancing the delivery of person and family-centred care by determining how individual-level, group-level and system-level values guide decision-making. Further research is needed to understand how various stakeholder groups balance these factors during transition planning in different health contexts.
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Affiliation(s)
- Sarah Carbone
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kristina Marie Kokorelias
- St John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Law
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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Shared Decision Making with Acutely Hospitalized, Older Poly-Medicated Patients: A Mixed-Methods Study in an Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116429. [PMID: 35682021 PMCID: PMC9180707 DOI: 10.3390/ijerph19116429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
Shared decision making (SDM) about medicine with older poly-medicated patients is vital to improving adherence and preventing medication-related hospital admissions, but it is difficult to achieve in practice. This study’s primary aim was to provide insight into the extent of SDM in medication decisions in the Emergency Department (ED) and to compare how it aligns with older poly-medicated patients’ preferences and needs. We applied a mixed-methods design to investigate SDM in medication decisions from two perspectives: (1) observational measurements with the observing patient involvement (OPTION 5) instrument of healthcare professionals’ SDM behavior in medication decisions and (2) semi-structured interviews with older poly-medicated patients. A convergent parallel analysis was performed. Sixty-five observations and fourteen interviews revealed four overall themes: (1) a low degree of SDM about medication, (2) a variation in the pro-active and non-active patients approach to conversations about medicine, (3) no information on side effects, and (4) a preference for medication reduction. The lack of SDM with older patients in the ED may increase inequality in health. Patients with low health literacy are at risk of safety threats, nonadherence, and preventable re-admissions. Therefore, healthcare professionals should systematically investigate older poly-medicated patients’ preferences and discuss the side effects and the possibility of reducing harmful medicine.
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Ketelaers SHJ, Jacobs A, Verrijssen ASE, Cnossen JS, van Hellemond IEG, Creemers GJM, Schreuder RM, Scholten HJ, Tolenaar JL, Bloemen JG, Rutten HJT, Burger JWA. A Multidisciplinary Approach for the Personalised Non-Operative Management of Elderly and Frail Rectal Cancer Patients Unable to Undergo TME Surgery. Cancers (Basel) 2022; 14:2368. [PMID: 35625976 PMCID: PMC9139821 DOI: 10.3390/cancers14102368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 02/07/2023] Open
Abstract
Despite it being the optimal curative approach, elderly and frail rectal cancer patients may not be able to undergo a total mesorectal excision. Frequently, no treatment is offered at all and the natural course of the disease is allowed to unfold. These patients are at risk for developing debilitating symptoms that impair quality of life and require palliative treatment. Recent advancements in non-operative treatment modalities have enhanced the toolbox of alternative treatment strategies in patients unable to undergo surgery. Therefore, a proposed strategy is to aim for the maximal non-operative treatment, in an effort to avoid the onset of debilitating symptoms, improve quality of life, and prolong survival. The complexity of treating elderly and frail patients requires a patient-centred approach to personalise treatment. The main challenge is to optimise the balance between local control of disease, patient preferences, and the burden of treatment. A comprehensive geriatric assessment is a crucial element within the multidisciplinary dialogue. Since limited knowledge is available on the optimal non-operative treatment strategy, these patients should be treated by dedicated multidisciplinary rectal cancer experts with special interest in the elderly and frail. The aim of this narrative review was to discuss a multidisciplinary patient-centred treatment approach and provide a practical suggestion of a successfully implemented clinical care pathway.
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Affiliation(s)
- Stijn H. J. Ketelaers
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
| | - Anne Jacobs
- Department of Gerontology and Geriatrics, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands;
| | - An-Sofie E. Verrijssen
- Department of Radiation Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (A.-S.E.V.); (J.S.C.)
| | - Jeltsje S. Cnossen
- Department of Radiation Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (A.-S.E.V.); (J.S.C.)
| | - Irene E. G. van Hellemond
- Department of Medical Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (I.E.G.v.H.); (G.-J.M.C.)
| | - Geert-Jan M. Creemers
- Department of Medical Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (I.E.G.v.H.); (G.-J.M.C.)
| | - Ramon-Michel Schreuder
- Department of Gastroenterology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands;
| | - Harm J. Scholten
- Department of Anaesthesiology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands;
| | - Jip L. Tolenaar
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
| | - Johanne G. Bloemen
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
| | - Harm J. T. Rutten
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
- GROW, School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jacobus W. A. Burger
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
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Kurasz AM, Smith GE, Curiel RE, Barker WW, Behar RC, Ramirez A, Armstrong MJ. Patient values in healthcare decision making among diverse older adults. PATIENT EDUCATION AND COUNSELING 2022; 105:1115-1122. [PMID: 34509339 PMCID: PMC8980797 DOI: 10.1016/j.pec.2021.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To provide high-quality healthcare, it is essential to understand values that guide the healthcare decisions of older adults. We investigated the types of values that culturally diverse older adults incorporate in medical decision making. METHODS Focus groups were held with older adults who varied in cognitive status (mildly impaired versus those with normal cognition) and ethnicity (Hispanic and non-Hispanic). Investigators used a qualitative descriptive approach to analyze transcripts and identify themes. RESULTS Forty-nine individuals (49% with cognitive impairment; 51% Hispanic) participated. Participants expressed a wide range of values relating to individual factors, familial/cultural beliefs and expectations, balancing risks and benefits, receiving decisional support, and considering values other than their own. Participants emphasized that values are individual-specific, influenced by aging, and change throughout life course. Participants described barriers and facilitators that interfere with or promote value solicitation and incorporation during medical encounters. CONCLUSION Study findings highlight that in older adults with various health experiences, cognitive and physical health status, and sociocultural backgrounds, medical decisions are influenced by a variety of values. PRACTICAL IMPLICATIONS Clinicians should take time to elicit, understand, and reassess the different types of values of older adults.
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Affiliation(s)
- Andrea M Kurasz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Glenn E Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rosie E Curiel
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Warren W Barker
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Raquel C Behar
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Alexandra Ramirez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
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Verberne WR, Stiggelbout AM, Bos WJW, van Delden JJM. Asking the right questions: towards a person-centered conception of shared decision-making regarding treatment of advanced chronic kidney disease in older patients. BMC Med Ethics 2022; 23:47. [PMID: 35477488 PMCID: PMC9047263 DOI: 10.1186/s12910-022-00784-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/18/2022] [Indexed: 12/18/2022] Open
Abstract
An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease (CKD), involving dialysis or conservative care. Shared decision-making (SDM) is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient’s values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs further implementation. A shift from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient’s perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient’s relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD.
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Affiliation(s)
- Wouter R Verberne
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands. .,Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands. .,Department of Internal Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes J M van Delden
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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Thevelin S, Pétein C, Metry B, Adam L, van Herksen A, Murphy K, Knol W, O'Mahony D, Rodondi N, Spinewine A, Dalleur O. Experience of hospital-initiated medication changes in older people with multimorbidity: a multicentre mixed-methods study embedded in the OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) trial. BMJ Qual Saf 2022; 31:888-898. [PMID: 35351779 DOI: 10.1136/bmjqs-2021-014372] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/24/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND A patient-centred approach to medicines optimisation is considered essential. The OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) trial evaluated the effectiveness of medication review with shared decision-making (SDM) in older people with multimorbidity. Beyond evaluating the clinical effectiveness, exploring the patient experience facilitates a better understanding of contextual factors and mechanisms affecting medication review effectiveness. OBJECTIVE To explore experiences of hospital-initiated medication changes in older people with multimorbidity. METHODS We conducted a multicentre mixed-methods study, embedded in the OPERAM trial, combining semi-structured interviews and the Beliefs about Medicines Questionnaire (BMQ) with a purposive sample of 48 patients (70-94 years) from four European countries. Interviews were analysed using the Framework approach. Trial implementation data on SDM were collected and the 9-item SDM questionnaire was conducted with 17 clinicians. RESULTS Patients generally displayed positive attitudes towards medication review, yet emphasised the importance of long-term, trusting relationships such as with their general practitioners for medication review. Many patients reported a lack of information and communication about medication changes and predominantly experienced paternalistic decision-making. Patients' beliefs that 'doctors know best', 'blind trust', having limited opportunities for questions, use of jargon terms by clinicians, 'feeling too ill', dismissive clinicians, etc highlight the powerlessness some patients felt during hospitalisation, all representing barriers to SDM. Conversely, involvement of companions, health literacy, empathetic and trusting patient-doctor relationships, facilitated SDM. Paradoxical to patients' experiential accounts, clinicians reported high levels of SDM. The BMQ showed that most patients had high necessity and low concern beliefs about medicines. Beliefs about medicines, experiencing benefits or harms from medication changes, illness perception, trust and balancing advice between different healthcare professionals all affected acceptance of medication changes. CONCLUSION To meet patients' needs, future medicines optimisation interventions should enhance information exchange, better prepare patients and clinicians for partnership in care and foster collaborative medication reviews across care settings.
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Affiliation(s)
- Stefanie Thevelin
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Catherine Pétein
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Beatrice Metry
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Luise Adam
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anniek van Herksen
- Department of Geriatric Medicine, Martini Ziekenhuis, Groningen, The Netherlands
| | - Kevin Murphy
- Pharmaceutical Care Research Group, School of Pharmacy, Cavanagh Pharmacy Building, University College Cork, Cork, Ireland
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital and Department of Medicine, University College Cork, Cork, Ireland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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Masterson D, Areskoug Josefsson K, Robert G, Nylander E, Kjellström S. Mapping definitions of co-production and co-design in health and social care: A systematic scoping review providing lessons for the future. Health Expect 2022; 25:902-913. [PMID: 35322510 PMCID: PMC9122425 DOI: 10.1111/hex.13470] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/22/2021] [Accepted: 02/21/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives This study aimed to explore how the concepts of co‐production and co‐design have been defined and applied in the context of health and social care and to identify the temporal adoption of the terms. Methods A systematic scoping review of CINAHL with Full Text, Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, PubMed and Scopus was conducted to identify studies exploring co‐production or co‐design in health and social care. Data regarding date and conceptual definitions were extracted. From the 2933 studies retrieved, 979 articles were included in this review. Results A network map of the sixty most common definitions and—through exploration of citations—eight definition clusters and a visual representation of how they interconnect and have informed each other over time are presented. Additional findings were as follows: (i) an increase in research exploring co‐production and co‐design in health and social care contexts; (ii) an increase in the number of new definitions during the last decade, despite just over a third of included articles providing no definition or explanation for their chosen concept; and (iii) an increase in the number of publications using the terms co‐production or co‐design while not involving citizens/patients/service users. Conclusions Co‐production and co‐design are conceptualized in a wide range of ways. Rather than seeking universal definitions of these terms, future applied research should focus on articulating the underlying principles and values that need to be translated and explored in practice. Patient and Public Contribution The search strategy and pilot results were presented at a workshop in May 2019 with patient and public contributors and researchers. Discussion here informed our next steps. During the analysis phase of the review, informal discussions were held once a month with a patient who has experience in patient and public involvement. As this involvement was conducted towards the end of the review, we agreed together that inclusion as an author would risk being tokenistic. Instead, acknowledgements were preferred. The next phase involves working as equal contributors to explore the values and principles of co‐production reported within the most common definitions.
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Affiliation(s)
- Daniel Masterson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Kristina Areskoug Josefsson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Behavioural Science, Oslo Metropolitan University, Oslo, Norway.,Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Glenn Robert
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Sofia Kjellström
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Affiliation(s)
- Adrian C Traeger
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Rowena Ivers
- Graduate Medicine, University of Wollongong, Wollongong, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
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Gauna F, Bendiane MK, Aim MA, Rousseau F, Rey D, Lecourtois D, Bonnet N, Durand MA, Tallet A, Mancini J. Lived experience and perceived advantages of therapeutic De-escalation: A qualitative study of older patients with breast cancer. J Geriatr Oncol 2022; 13:600-605. [PMID: 35115271 DOI: 10.1016/j.jgo.2022.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION One option for therapeutic de-escalation in older women with early breast cancer (EBC) is partial breast irradiation (PBI) instead of whole-breast irradiation (WBI) when the latter has no clear advantages. We aimed to explore the decision-making processes and the lived experiences of WBI and PBI from the perspectives of older women with EBC. MATERIALS AND METHODS Thematic content analysis was performed on qualitative data collected using narrative interviews. RESULTS Twenty-two women aged 65 and over participated (ten patients who underwent WBI and twelve who underwent PBI). We identified three themes from their narratives: 1) Acceptance of a paternalistic relationship with physicians, 2) Strong need for an informed choice, and 3) PBI can help people conceal cancer-related physical marks. Narratives underlined participants' preferences for each of the two treatments and their perceptions about therapeutic de-escalation. Misconceptions about therapeutic de-escalation were observed. DISCUSSION When providing information about EBC treatment options, patients' perceived burden of side effects should be considered. Moreover, eliciting the value older patients place on available breast cancer treatments, as well as their related goals and preferences, could foster their participation in the therapeutic de-escalation decision-making process.
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Affiliation(s)
- Fatima Gauna
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | - Marie-Anastasie Aim
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France; LPS EA 849, Aix Marseille Univ, Aix-en-Provence, France; Delegation for Clinical Research and Innovation, APHM, Marseille, France
| | | | - Dominique Rey
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | - Delphine Lecourtois
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | | | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA; UMR 1027, University Toulouse III Paul Sabatier, Toulouse, France
| | | | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France; APHM, BIOSTIC, Hop Timone, Marseille, France.
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Aljaffary A, Alsheddi F, Alzahrani R, Alamoudi S, Aljuwair M, Alrawiai S, Aljabri D, Althumairi A, Hariri B, Alumran A. Shared Decision-Making: A Cross-Sectional Study Assessing Patients Awareness and Preferences in Saudi Arabia. Patient Prefer Adherence 2022; 16:1005-1015. [PMID: 35444407 PMCID: PMC9013678 DOI: 10.2147/ppa.s332638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM Shared decision-making (SDM) has become broadly accepted during the consultation, especially when there are many options of treatment. This study aims to assess patients' levels of awareness and preferences of SDM in Saudi Arabia. METHODS This is a cross-sectional study targeting patients in Saudi Arabia. Two validated questionnaires were used, the first validated questionnaire focuses on measuring knowledge, attitude and experiences of shared-decision making. The second questionnaire is the the Autonomy-Preference-Index focusing on patients' preferences for being involved in SDM. Relevant items to the study aim were chosen and translated into Arabic. Psychometric testing was conducted for Arabic and English versions and tested for content and face validity. The questionnaire administered online via social media channels, between February 2021 and May 2021. A total of 411 respondents completed the questionnaire. RESULTS The findings showed a positive association between awareness and preferences of SDM among patients in Saudi Arabia. In the awareness of the SDM domain, females reported higher scores than male participants (t = -4.504, P < 0.001). Saudis reported higher scores in their awareness of SDM than non-Saudis (t = 2.569, P = 0.011). Participants without health insurance reported higher scores in their awareness of SDM than those insured (t = -2.130, P = 0.034). Participants with degree have higher knowledge levels than participants with no degree (f = 10.034, P < 0.001). Females reported higher scores in their preferences of SDM than the male (t = -2.099, P = 0.036). Participants who visited private health-care settings in their last clinical encounter reported higher preferences of SDM than participants who received care in other settings (f = 2.653, P = 0.048). CONCLUSION The study concludes that the more aware a patient is, the more likely they prefer SDM practice. This finding can support health-care policymakers in developing SDM policies that enhance patient-centered care.
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Affiliation(s)
- Afnan Aljaffary
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Correspondence: Afnan Aljaffary, Email
| | - Fatimah Alsheddi
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Raghad Alzahrani
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Somayyah Alamoudi
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mona Aljuwair
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sumaiah Alrawiai
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Duaa Aljabri
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Althumairi
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bayan Hariri
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Alumran
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Westlake D, Ekman I, Britten N, Lloyd H. Terms of engagement for working with patients in a person-centred partnership: A secondary analysis of qualitative data. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:330-340. [PMID: 33955640 DOI: 10.1111/hsc.13406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Evidence is emerging of the potential of person-centred approaches to create partnerships between professionals and patients while also containing healthcare costs. This is important for enhancing outcomes in individuals with complex needs, who consistently report poor experiences with care. The shift towards person-centred care (PCC) is, however, a radical departure from the norm, with increased expectations of both professional and patient. Although there have been studies on the ways in which health care professionals can modify practice to enhance PCC, not all patients welcome changes to their care delivery or understand the aim of the new approach. Without engagement and understanding from the patient, a PCC approach will fail to initiate. Few studies explore how, why and in what circumstances patients become more involved in their care and what professionals can do to enhance participation. We conducted a secondary analysis of qualitative data to examine this issue. Data were collected between 2014 and 2018 from primary care-based PCC projects across the southwest of England. Supported by people with experience (practitioners and those receiving treatment), theory building workshops developed an explanatory framework that identified contextual factors and mechanisms likely to contribute to effective engagement. Our results show that engagement in a care partnership is achieved through trust and a patient's sense of candidacy. Shared understanding of purpose, clarity of expectations and power sharing were found to facilitate trusted relationships between professional and patient and encourage candidacy. Only then is it possible to develop goals that are meaningful to the patient. Our theory of engagement applies to professionals and patients alike but places the initial burden of responsibility on those who hold the most power: the professional and the system. This theory has the potential to explain patient engagement in PCC and a range of other service interventions, treatments and intervention research.
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Affiliation(s)
- Debra Westlake
- National Institute for Health Research, Applied Research Collaboration South West Peninsula (PenARC), Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Inger Ekman
- Centre for Person-Centred Care University of Gothenburg (GPCC), Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicky Britten
- National Institute for Health Research Applied Research Collaboration Southwest Peninusula (PenARC), University of Exeter Medical School, St. Luke's Campus, Exeter, UK
| | - Helen Lloyd
- National Institute for Health Research, Applied Research Collaboration South West Peninsula (PenARC), Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
- School of Psychology, Plymouth University, Plymouth, UK
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Jayes M, Borrett S, Bose A. Mental capacity legislation and communication disability: A cross-sectional survey exploring the impact of the COVID-19 pandemic on the provision of specialist decision-making support by UK SLTs. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:172-181. [PMID: 34882902 PMCID: PMC10015992 DOI: 10.1111/1460-6984.12685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Mental capacity legislation in the UK is designed to safeguard the rights of people who may need support, or may be unable, to make autonomous decisions. Very limited evidence has been published about the impact of the COVID-19 pandemic on the application of mental capacity legislation and, to our knowledge, none on the ability of speech and language therapists (SLTs) to support people with communication disabilities to engage in decision-making. AIMS To describe how UK SLTs supported people with communication disabilities to make decisions and participate in mental capacity assessments, best interests decision-making and advance care planning during the COVID-19 pandemic. METHODS & PROCEDURES This descriptive, cross-sectional study used an online survey to collect quantitative and qualitative data about SLTs' practice experiences between August and November 2020. SLTs working with a range of adult clinical populations in different care settings were sampled purposively from all UK jurisdictions. Participants were recruited through professional networks and social media. Quantitative data were summarized using descriptive statistics. Qualitative data were analysed thematically. OUTCOMES & RESULTS Data were collected from 107 SLTs working in a range of settings across all four UK nations. The sample included SLTs working with people with neurological conditions, learning disabilities, mental health conditions and acute confusion. The need for SLT support appeared to increase during the pandemic. Most respondents were still able to offer support; however, the amount and nature of support varied. Quality of support was impacted by adjustments associated with social distancing and infection control restrictions. Personal protective equipment (PPE) was identified as a barrier to communication. Indirect working methods (e.g., telehealth) were inaccessible to some people with communication disabilities. Most respondents felt confident that legal requirements were upheld, but suggested this group was less able to engage in decision-making and had reduced access to support to manage their own health conditions. CONCLUSIONS & IMPLICATIONS Some SLT services were limited in their ability to meet the decision-making support needs of people with communication disabilities during the COVID-19 pandemic due to structural and systemic barriers. This suggests that existing inequities in the provision of care for people with communication disabilities in the UK were amplified during the pandemic. WHAT THIS PAPER ADDS What is already known on the subject People with communication disabilities may require support from healthcare professionals, including SLTs, to make decisions and communicate their wishes and preferences about their care, in line with mental capacity legislation. There is a lack of published evidence relating to how changes in staff deployment and resource during the COVID-19 pandemic may have impacted on the ability of SLTs to provide this support. What this paper adds to existing knowledge This study provides novel evidence about the ways in which UK SLTs supported people with communication disabilities to engage in mental capacity assessments, best interests decision-making and advance care planning during the COVID-19 pandemic. In some cases, the amount and quality of decision-making support available was affected negatively due to changes in healthcare delivery and resource management and SLT working practices. What are the potential or actual clinical implications of this work? This study suggests that some people with communication disabilities experienced greater barriers to receiving professional support to maximize their autonomy and manage their health conditions during the COVID-19 pandemic. Speech and language therapy services and healthcare commissioners should consider how best to ensure equitable service delivery to this population in resource-limited situations.
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Affiliation(s)
- Mark Jayes
- Faculty of Health and EducationManchester Metropolitan UniversityManchesterUK
| | - Sophie Borrett
- Speech and Language TherapyPortsmouth University Hospitals NHS TrustPortsmouthUK
| | - Arpita Bose
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
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Tannou T, Menand E, Veillard D, Contreras JB, Slekovec C, Daucourt V, Somme D, Corvol A. Geriatric Choosing Wisely choice of recommendations in France: a pragmatic approach based on clinical audits. BMC Geriatr 2021; 21:705. [PMID: 34911444 PMCID: PMC8672546 DOI: 10.1186/s12877-021-02619-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background The international Choosing Wisely campaign seeks to improve the appropriateness of care, notably through large campaigns among physicians and users designed to raise awareness of the risks inherent in overmedication. Methods In deploying the Choosing Wisely campaign, the French Society of Geriatrics and Gerontology chose early operationalization via a tool for clinical audit over a limited area before progressive dissemination. This enabled validation of four consensual recommendations concerning the management of urinary tract infections, the prolonged use of anxiolytics, the use of neuroleptics in dementia syndromes, and the use of statins in primary prevention. The fifth recommendation concerns the importance of a dialogue on the level of care. It was written by patient representatives directly involved in the campaign. Results The first cross-regional campaign in France involved 5337 chart screenings in 43 health facilities. Analysis of the results showed an important variability in practices between institutions and significant percentage of inappropriate prescriptions, notably of psychotropic medication. Discussion The high rate of participation of target institutions shows that geriatrics professionals are interested in the evaluation and optimization of professional practices. Frequent overuse of psychotropic medication highlights the need of campaigns to raise awareness and encourage deprescribing.
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Affiliation(s)
- T Tannou
- Centre Hospitalier et Universitaire de Besançon, Service de Gériatrie, F-25000, Besançon, France. .,Centre Hospitalier et Universitaire de Besançon, INSERM CIC 1431, équipe "Ethique et progrès médical", F-25000, Besançon, France. .,Université de Franche-Comté, UFR des Sciences de la Santé, Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, F-25000, Besançon, France. .,Centre de recherche, Institut Universitaire de Gériatrie, Montréal, QC, Canada. .,Service de gériatrie, CHU de Besançon, Boulevard Fleming, 25030, Besancon, France.
| | - E Menand
- Univ Rennes, CHU Rennes, Service de Gériatrie, F-35000, Rennes, France
| | - D Veillard
- CAPPS, structure régionale d'appui à la qualité des soins et la sécurité des patients, Rennes, France.,Univ Rennes, CHU Rennes, Service de Santé Publique, F-35000, Rennes, France
| | - J Berthou Contreras
- OMéDIT, Observatoire du Médicament des Dispositifs médicaux et des Innovations Thérapeutiques, CHU de Besançon, Besançon, France
| | - C Slekovec
- CPIAS, Centre d'appui pour la Prévention des Infections Associées aux Soins Bourgogne-Franche-Comté, CHU de Besançon, Besançon, France
| | - V Daucourt
- RéQua, Structure régionale d'appui à la qualité des soins et la sécurité des patients, Besançon, France
| | - D Somme
- Univ Rennes, CHU Rennes, Service de Gériatrie, F-35000, Rennes, France.,Univ Rennes, CHU Rennes, CNRS, ARENES, UMR 6051, F-35000, Rennes, France
| | - A Corvol
- Univ Rennes, CHU Rennes, Service de Gériatrie, F-35000, Rennes, France.,Univ Rennes, CHU Rennes, CNRS, ARENES, UMR 6051, F-35000, Rennes, France
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Schusselé Filliettaz S, Moiroux S, Marchand G, Gilles I, Peytremann-Bridevaux I. Transitional shared decision-making processes for patients with complex needs: A feasibility study. J Eval Clin Pract 2021; 27:1326-1334. [PMID: 33742747 DOI: 10.1111/jep.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Shared decision-making (SDM) processes, combining patients' and professionals' perspectives, are especially necessary for patients with complex needs (CNs) during their care transitions. In 2016, we started implementing interprofessional and interinstitutional SDM processes (IIPs) for patients admitted to a short-stay unit (SSU) for inpatient care and then followed-up by primary care providers. Two types of IIPs were identified: (a) iterative IIPs, and (b) meeting IIPs. These differed in terms of the timing of SDM processes: whereas the former were multilateral and iterative, meeting IIPs were simultaneous. However, the two processes had similar outcomes and participants had similar characteristics. The intervention included other components, such as CNs assessment and a care coordinator position. The present study aimed to assess the feasibility of the intervention's implementation. METHODS The intervention's feasibility was assessed using fidelity and coverage indicators. We collected data from the patients' records on (a) patients' and professionals' characteristics, (b) the fidelity (CNs evaluations and occurrences of IIPs), and (c) the intervention's coverage (types of IIPs, participants). RESULTS The study included 453 patients between September 2017 and February 2019: mean age of 82.3 years, 65.6% women and 61.1% considered to have CNs. For patients with CNs, iterative IIPs and meeting IIPs occurred in 78.3% and 23.8% of cases, respectively. 35.1% of iterative IIPs and 8.8% of meeting IIPs for patients with CNs involved patients or their informal caregivers, inpatient professionals, primary care physicians and homecare professionals. DISCUSSION These results showed that an intervention targeting the implementation of formalized IIPs for SDM in transitional care was feasible. However, to improve the evaluation of such interventions, other methods should be used to measure their appropriateness and acceptability. Additionally, assessing the effects of IIPs would legitimize their funding, supporting their sustainability and generalisability.
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Affiliation(s)
- Séverine Schusselé Filliettaz
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Association for the Promotion of Integrated Patient Care Networks (PRISM), Geneva, Switzerland
| | | | | | - Ingrid Gilles
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Schusselé Filliettaz S, Moiroux S, Marchand G, Gilles I, Peytremann-Bridevaux I. Realist evaluation of a pilot intervention implementing interprofessional and interinstitutional processes for transitional care. Home Health Care Serv Q 2021; 40:302-323. [PMID: 34689706 DOI: 10.1080/01621424.2021.1989356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In 2016, in Switzerland, we implemented transitional interprofessional and interinstitutional shared decision-making processes (IIPs) between a short-stay inpatient care unit (SSU) and primary care professionals. Between 2018 and 2019, we evaluated this intervention using a realist design to answer the following questions: for whom, with whom, in which context and how have IIPs been implemented? Our initial theory was tested via interviews with patients, primary care professionals and staff from the SSU. Results showed that a patient's stay at the SSU, with actors committed to facilitating IIPs, reinforced the perceived appropriateness and implementation of those IIPs. However, this appropriateness varied according to different contextual elements, such as the complexity of needs, preexisting collaborative practices and the purpose of the inpatient stay. Since IIPs occurred in a context of fragmented practices, proactive and sustained efforts are required of the actors implementing them and the organizations supporting them.
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Affiliation(s)
- Séverine Schusselé Filliettaz
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Association for the Promotion of Integrated Patient Care Networks (PRISM), Geneva, Switzerland
| | | | | | - Ingrid Gilles
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Vogel A, Balzer F, Fürstenau D. The social construction of the patient-physician relationship in the clinical encounter: Media frames on shared decision making in Germany. Soc Sci Med 2021; 289:114420. [PMID: 34607053 DOI: 10.1016/j.socscimed.2021.114420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
The literature on healthcare management has noted that shared decision-making (SDM) - a practice of organizing joint decisions between healthcare professionals and patients - should improve healthcare outcomes through patient engagement and autonomy, fostering patient-centeredness. While SDM projects are implemented across Europe and the US, the diffusion of the practice remains partial, and its' conceptualization scattered. Healthcare management literature explores SDM on the underlying assumption that its limited diffusion results from an information problem, implying objective criteria and rational behavior. The purpose of this research is to study the social construction of SDM within the clinical setting and the underlying rationales using the case of one of the largest healthcare markets worldwide - Germany. To capture the complexity of SDM, a frame analysis is conducted on its medial representations. News media is both influential in shaping public opinion, as well as in generating public discourse. This analysis enables one to elaborate different facets of the construct of SDM, to capture inherent patterns of facilitating and obstructing aspects and to explore consequences for the diffusion of SDM. Three facilitating and three obstructive frames on the implementation of SDM were identified. The polarities of these frames range from the questioning of one's decision-making authority to the perception of individual competence and decision-making agency. Moreover, this study reflects on how physicians' and patients' role for SDM is conceived.
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Affiliation(s)
- Amyn Vogel
- Freie Universität Berlin, School of Business & Economics, Department of Information Systems, Germany.
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Daniel Fürstenau
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Digitalization, Copenhagen Business School, Denmark.
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