Background: Frailty is considered to be an important risk factor for mortality in hospitalized patients. This study evaluates a preoperative frailty-screening tool called Anesthesia Geriatric Evaluation (AGE). Research into the concept of frailty, with a focus on multidisciplinary team meetings, may provide further insight for health care professionals in the understanding of frailty in everyday care situations. Methods: The research method chosen for this research is QUAGOL: Qualitative Analysis Guide of Leuven, which aims to reconstruct the story of the participants on a theoretical level and analyze the concepts found. Results: The following themes illustrate the analyzed concepts found: competence, resilience, sharing responsibility, broad frame of reference, obligation, and significance. Conclusion: AGE seems to create more awareness among health care professionals about frailty and tries to involve patients in their care process by making them aware of their abilities, motivation, and involving them in decisions to be made. This study shows that a shared decision-making process for surgical patients is often difficult to accomplish since AGE is still a paternalistic process of a multidisciplinary team with a medical perspective.
Rationale, aims and objectives: Patient-centered care is considered a vital component of good quality care for breast cancer patients. Nevertheless, the implementation of this valuable concept in clinical practice appears to be difficult. The goal of this study is to bridge the gap between theoretical elaboration of "patient-centered care" and clinical practice. To that purpose, a scoping analysis was performed of the application of the term "patient-centered care in breast cancer treatment" in present-day literature.Method: For data-extraction, a literature search was performed extracting references that were published in 2018 and included the terms "patient-centered care" and "breast cancer". The articles were systematically traced for answers to the following three questions: "What is patient-centered care?", "Why perform patient-centered care?", and "How to realize patient-centered care?". For the content analysis, these answers were coded and assembled into meaningful clusters until separate themes arose which concur with various interpretations of the term "patient-centered care".Results: A total of 60 publications were retained for analysis. Traced answers to the three questions "what", "why", and "how" varied considerably in recent literature concerning breast cancer treatment. Despite the inconsistent use of the term "patient-centered care," we did not find any critical consideration about the nature of the concept, regardless of the applied interpretation. Interventions that are supposed to contribute to the heterogeneous concept of patient-centered care as such, seem to be judged desirable, virtually without empirical justification. Conclusions:We propose, contrary to previous efforts to define "patient-centered care" more accurately, to embrace the heterogeneity of the concept and apply "patientcentered care" as an umbrella-term for all healthcare that intends to contribute to the acknowledgement of the person in the patient. For the justification of measures to realize patient-centered care for breast cancer patients, instead of a mere contribution to the abstract concept, we insist on the demonstration of desirable real-world effects.
Aims and objectives: The COVID-19 pandemic caused an increase in hospitalizations for frail older people and required healthcare professional to make difficult ethical and medical decisions regarding intensive care unit admission and treatment. This study investigates the experiences of healthcare professionals with the use of a decision support tool when discussing treatment limitations with older patients with COVID-19. Methods: A qualitative approach was chosen to obtain further in-depth information on the experiences of the healthcare professionals with the conversations about treatment limitation and on the contribution of a decision support tool for frail older adults with COVID-19. The framework method was used for the data analysis. Results: The following themes illustrate the analyzed concepts for the subject conversations about treatment limitation: careful consideration, the conversation is a part of the job, the burden of the conversation, scheduling conversation and acquiring skills to perform the conversation. The concepts of the theme AGE-ICU evaluation are included in the following themes: considered and comprehensible overview, confirmation of own assessment, every decision is context and person dependent, contributes to considered decision and tool not needed because of own expertise. Conclusion: A decision support tool for older patients with COVID-19 may help the healthcare professional to objectify the patients’ health status and functioning and discuss risk factors for adverse outcomes. Besides this, the tool helps to initiate the difficult conversation with the patient and their family. Finally, the AGE-ICU contributes to shared-decision making because it helps patients to understand the suggested decision and patients are more involved in the decision-making process.
Rationale, aims and objectives Patient-centered care is considered as a vital component of good quality of care for breast cancer patients. Nevertheless, the implementation of this valuable theoretical concept into practice appears to be difficult. The goal of this study was to bridge the gap between the theoretical elaboration of 'patient-centered care' and clinical practice. For that purpose, the current application of the term 'patient-centered care in breast cancer treatment' was deduced from present-day literature. Method The methodology of a scoping review was employed. Results A notable lack of consistency in use of the term 'patient-centered care' is demonstrated in recent literature concerning breast cancer treatment. We also observe an unambiguous positive vision on this rather vague concept. Conclusions Contrary to previous efforts to define 'patientcentered care' more narrowly, we propose to embrace the heterogeneity of this concept and apply 'patient-centered care' as an umbrella-term for all healthcare that (intends to) contribute to the acknowledgement of the person in the patient. For the justification of measures to realize patient-centered care, we insist on the demonstration of desirable real-world effects, instead of a mere contribution to this abstract term.
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