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Murawski A, Ramirez-Zohfeld V, Mell J, Tschoe M, Schierer A, Olvera C, Brett J, Gratch J, Lindquist LA. NegotiAge: Development and pilot testing of an artificial intelligence-based family caregiver negotiation program. J Am Geriatr Soc 2024; 72:1112-1121. [PMID: 38217356 PMCID: PMC11018462 DOI: 10.1111/jgs.18775] [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: 09/05/2023] [Revised: 12/02/2023] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Family caregivers of people with Alzheimer's disease experience conflicts as they navigate health care but lack training to resolve these disputes. We sought to develop and pilot test an artificial-intelligence negotiation training program, NegotiAge, for family caregivers. METHODS We convened negotiation experts, a geriatrician, a social worker, and community-based family caregivers. Content matter experts created short videos to teach negotiation skills. Caregivers generated dialogue surrounding conflicts. Computer scientists utilized the dialogue with the Interactive Arbitration Guide Online (IAGO) platform to develop avatar-based agents (e.g., sibling, older adult, physician) for caregivers to practice negotiating. Pilot testing was conducted with family caregivers to assess usability (USE) and satisfaction (open-ended questions with thematic analysis). RESULTS Development: With NegotiAge, caregivers progress through didactic material, then receive scenarios to negotiate (e.g., physician recommends gastric tube, sibling disagrees with home support, older adult refusing support). Caregivers negotiate in real-time with avatars who are designed to act like humans, including emotional tactics and irrational behaviors. Caregivers send/receive offers, using tactics until either mutual agreement or time expires. Immediate feedback is generated for the user to improve skills training. Pilot testing: Family caregivers (n = 12) completed the program and survey. USE questionnaire (Likert scale 1-7) subset scores revealed: (1) Useful-Mean 5.69 (SD 0.76); (2) Ease-Mean 5.24 (SD 0.96); (3) Learn-Mean 5.69 (SD 0.74); (4) Satisfy-Mean 5.62 (SD 1.10). Items that received over 80% agreements were: It helps me be more effective; It helps me be more productive; It is useful; It gives me more control over the activities in my life; It makes the things I want to accomplish easier to get done. Participants were highly satisfied and found NegotiAge fun to use (91.7%), with 100% who would recommend it to a friend. CONCLUSION NegotiAge is an Artificial-Intelligent Caregiver Negotiation Program, that is usable and feasible for family caregivers to become familiar with negotiating conflicts commonly seen in health care.
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Affiliation(s)
- Alaine Murawski
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Vanessa Ramirez-Zohfeld
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Johnathan Mell
- University of Central Florida, Department of Computer Science; Orlando, FL, USA
| | - Marianne Tschoe
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Allison Schierer
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Charles Olvera
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Jeanne Brett
- Northwestern University, Kellogg School of Management; Evanston, IL USA
| | - Jonathan Gratch
- University of Southern California, Viterbi School of Engineering; Los Angeles, CA, USA
| | - Lee A. Lindquist
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
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Tietbohl CK, Dafoe A, Jordan SR, Huebschmann AG, Lum HD, Bowles KH, Jones CD. Palliative Care across Settings: Perspectives from Inpatient, Primary Care, and Home Health Care Providers and Staff. Am J Hosp Palliat Care 2023; 40:1371-1378. [PMID: 36908002 PMCID: PMC10495535 DOI: 10.1177/10499091231163156] [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: 03/14/2023] Open
Abstract
BACKGROUND Early introduction of palliative care can improve patient-centered outcomes for older adults with complex medical conditions. However, identifying the need for and introducing palliative care with patients and caregivers is often difficult. We aim to identify how and why a multi-setting approach to palliative care discussions may improve the identification of palliative care needs and how to facilitate these conversations. METHODS Descriptive qualitative study to inform the development and future pilot testing of a model to improve recognition of, and support for, unmet palliative care needs in home health care (HHC). Thematic analysis of semi-structured interviews with providers across inpatient (n = 11), primary care (n = 17), and HHC settings (n = 10). RESULTS Four key themes emerged: 1) providers across settings can identify palliative care needs using their unique perspectives of the patient's care, 2) identifying palliative care needs is challenging due to infrequent communication and lack of shared information between providers, 3) importance of identifying a clinical lead of patient care who will direct palliative care discussions (primary care provider), and 4) importance of identifying a care coordination lead (HHC) to bridge communication among multi-setting providers. These themes highlight a multi-setting approach that would improve the frequency and quality of palliative care discussions. CONCLUSIONS A lack of structured communication across settings is a major barrier to introducing and providing palliative care. A novel model that improves communication and coordination of palliative care across HHC, inpatient and primary care providers may facilitate identifying and addressing palliative care needs in medically complex older adults.
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Affiliation(s)
- Caroline K. Tietbohl
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Ashley Dafoe
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Sarah R. Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amy G. Huebschmann
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Ludeman Family Center for Women’s Health Research, University of Colorado School of Medicine, Department of Medicine, Aurora, CO, USA
| | - Hillary D. Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kathryn H. Bowles
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Christine D. Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA
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Patient Interaction Involving Older Adults: Provider vs. Caregiver Expectations. Geriatrics (Basel) 2022; 7:geriatrics7050101. [PMID: 36136810 PMCID: PMC9498497 DOI: 10.3390/geriatrics7050101] [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: 06/02/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
This paper presents a study of the interaction between healthcare providers (HCPs) and older patients and their caregivers. The paper first presents results from a rapid review and narrative synthesis using PubMed and Google Scholar of HCP/patient/caregiver interactions involving older patients; these results then informed the design of a survey administered to HCPs and caregivers using a range of scenarios and their ratings of appropriateness of different responses, to explore where expectations align or differ between HCPs and caregivers. In analyzing ratings, the research found HCPs and caregivers generally approach the older adult encounter with similar expectations, but differences for specific situations are informative. HCPs appear to better recognize when there is a need to show empathy, as when a patient is frustrated or anxious. HCPs, overall, offer more calming responses, especially in embarrassing, upsetting, or worrying situations. For older patients of advanced age, HCPs value engagement with patients more than caregivers, but HCPs are more aligned with caregivers in their ratings of how to engage caregivers. Compared to caregivers, HCPs focus more on simplifying the description of treatment rather than using thorough explanations when a patient expresses hesitancy or avoidance. The results from this work suggest that having a fuller understanding of the different participants’ expectations may improve communication and identify potential pitfalls. A better understanding may also lead to changes in how students in the healthcare fields are trained; having better insight into this relationship will prepare them for interacting with older patients while addressing the needs of caregivers.
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Allen J, Lobchuk M, Livingston PM, Layton N, Hutchinson AM. Informal carers' support needs, facilitators and barriers in the transitional care of older adults: A qualitative study. Health Expect 2022; 25:2876-2892. [PMID: 36069335 DOI: 10.1111/hex.13596] [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: 06/08/2022] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Inclusion of informal carers in transitional care is challenging because of fast throughput and service fragmentation. This study aimed to understand informal carers' needs during the care transitions of older adults from inpatient care to the community. METHODS A qualitative exploratory design was used with mixed-methods data collection. Seventeen semi-structured telephone interviews were conducted with family carers; one focus group was conducted by videoconference with two family carers and three community-based advocacy and aged care providers; and eight semi-structured telephone interviews were undertaken with healthcare practitioners from rehabilitation services. Data were thematically analysed. FINDINGS All carers described the main social challenge that they needed to address in transitional care as 'Needing to sustain family'. Carers reported their social needs across five solutions: 'Partnering with carers', 'Advocating for discharge', 'Accessing streamlined multidisciplinary care', 'Knowing how to care' and 'Accessing follow-up care in the community'. Focus group participants endorsed the findings from the carer interviews and added the theme 'Putting responsibility back onto carers'. All healthcare practitioners described the main social challenge that they needed to address as 'Needing to engage carers'. They reported their social solutions in three themes: 'Communicating with carers', 'Planning with carers' and 'Educating carers'. DISCUSSION Findings highlight the importance of reconstructing the meaning of transitional care and relevant outcomes to be inclusive of carers' experiences and their focus on sustaining family. Transitional care that includes carers should commence at the time of hospital admission of the older adult. CONCLUSIONS Future sustainable and high-quality health services for older adults will require transitional care that includes carers and older adults and efficient use of inpatient and community care resources. Healthcare professionals will require education and skills in the provision of transitional care that includes carers. To meet carers' support needs, models of transitional care inclusive of carers and older adults should be developed, implemented and evaluated. PUBLIC CONTRIBUTION This study was conducted with the guidance of a Carer Advisory Group comprising informal carers with experience of care transitions of older adults they support and community-based organizations providing care and advocacy support to informal carers.
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Affiliation(s)
- Jacqueline Allen
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Michelle Lobchuk
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia M Livingston
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Natasha Layton
- Rehabilitation, Ageing and Independent Living Research Centre, Peninsula Campus, Monash University, Frankston, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Jones CD, Bowles KH. Emerging Challenges and Opportunities for Home Health Care in the Time of COVID-19. J Am Med Dir Assoc 2020; 21:1517-1518. [PMID: 33138933 PMCID: PMC7498200 DOI: 10.1016/j.jamda.2020.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA; Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA.
| | - Kathryn H Bowles
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
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Rath K, Kreitzer N, Schlichter E, Lopez O, Ferioli S, Ngwenya LB, Foreman B. The Experience of a Neurocritical Care Admission and Discharge for Patients and Their Families: A Qualitative Analysis. J Neurosci Nurs 2020; 52:179-185. [PMID: 32371682 PMCID: PMC7335345 DOI: 10.1097/jnn.0000000000000515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A qualitative assessment of discharge resource needs is important for developing evidence-based care improvements in neurocritically ill patients. METHODS We conducted a quality improvement initiative at an academic hospital and included all patients admitted to the neuroscience intensive care unit (ICU) during an 18-month period. Telephone assessments were made at 3 to 6 months after admission. Patients or caregivers were asked whether they had adequate resources upon discharge and whether they had any unanswered questions. The content of responses was reviewed by a neurointensivist and a neurocritical care nurse practitioner. A structured codebook was developed, organized into themes, and applied to the responses. RESULTS Sixty-one patients or caregivers responded regarding access to resources at discharge with 114 individual codable responses. Responses centered around 5 themes with 23 unique codes: satisfied, needs improvement, dissatisfied, poor post-ICU care, and poor health. The most frequently coded responses were that caregivers believed their loved one had experienced an unclear discharge (n = 11) or premature discharge (n = 12). Two hundred four patients or caregivers responded regarding unanswered questions or additional comments at follow-up, with 516 codable responses. These centered around 6 themes with 26 unique codes: positive experience, negative experience, neutral experience, medical questions, ongoing medical care or concern, or remembrance of time spent in the ICU. The most frequent response was that caregivers or patients stated that they received good care (n = 115). Multiple concerns were brought up, including lack of follow-up after hospitalization (n = 15) and dissatisfaction with post-ICU care (n = 15). CONCLUSIONS Obtaining qualitative responses after discharge provided insight into the transition from critical care. This could form the basis for an intervention to provide a smoother transition from the ICU to the outpatient setting.
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Affiliation(s)
- Kelly Rath
- University of Cincinnati Division of Neurocritical Care
- University of Cincinnati Department of Neurology
- University of Cincinnati College of Nursing
| | - Natalie Kreitzer
- University of Cincinnati Division of Neurocritical Care
- University of Cincinnati Department of Emergency Medicine
| | - Erika Schlichter
- University of Cincinnati Division of Neurocritical Care
- University of Cincinnati Department of Neurology
- University of Cincinnati College of Nursing
| | - Omar Lopez
- University of Cincinnati Division of Neurocritical Care
- University of Cincinnati Department of Neurology
- University of Cincinnati Collaborative for Research on Acute Neurological Injury
| | - Simona Ferioli
- University of Cincinnati Division of Neurocritical Care
- University of Cincinnati Department of Neurology
| | - Laura B. Ngwenya
- University of Cincinnati Department of Neurology
- University of Cincinnati Collaborative for Research on Acute Neurological Injury
- University of Cincinnati Department of Neurosurgery
| | - Brandon Foreman
- University of Cincinnati Division of Neurocritical Care
- University of Cincinnati Department of Neurology
- University of Cincinnati Collaborative for Research on Acute Neurological Injury
- University of Cincinnati Department of Neurosurgery
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Rajanala A, Ramirez-Zohfeld V, O'Conor R, Brown D, Lindquist LA. Conflicts Experienced by Caregivers of Older Adults With the Health-Care System. J Patient Exp 2020; 7:1130-1135. [PMID: 33457555 PMCID: PMC7786744 DOI: 10.1177/2374373520921688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Family caregivers of older adults frequently navigate the health system for their loved ones. As older adults experience more medical issues, the interactions between caregivers and the health system can be fraught with conflicts. Objective: To characterize the conflicts that caregivers of older adults experience with the health-care system. Methods: A cross-sectional national online survey with open-ended questions was conducted among family caregivers ascertaining experiences with the health-care system. Qualitative thematic analysis was completed using constant comparative analysis and review by a third author. Results: Over a 2-month period, 97 caregivers completed the survey. Common themes where caregivers experienced conflicts were Difficulty With Accessing/Communicating With Providers, Delivery of Emergency Care, Disjointed Transitional Care, Unaddressed Clinical Concerns, and Financial. Caregivers reported needing to act as patient advocates in the conflicts with the health-care system. Conclusion: Understanding the conflicts that family caregivers encounter with the health system provides potential targets for future interventions to combat the challenges faced by caregivers of older adults and ultimately improve delivery of geriatric care.
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Affiliation(s)
- Alekya Rajanala
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rachel O'Conor
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Lee A Lindquist
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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