Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

Milte, Catherine M.; Ratcliffe, Julie; Davies, Owen; Whitehead, Craig; Masters, Stacey; Crotty, Maria

doi:10.1111/hex.12076

Cited by 31 publications

(55 citation statements)

References 34 publications

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“…This theme includes research about negotiation of decision‐making (Allen, ), carer participation in professional meetings (Griffith et al ., ), advanced care planning (Ng et al ., ) and staff/carer decision‐making relationships (Karlsson et al ., ). Carer engagement in shared decision‐making becomes a necessity in the case of patients that are not able to make decisions about their care, for example due to dementia (Milte et al ., ; Karlsson et al ., ). Carer engagement in shared decision‐making can challenge established cultures of professional control over caring processes (Allen, ; Jacelon, ) and expectations about the roles of staff and carers (Walker & Dewar, ).…”

Section: Resultsmentioning

confidence: 97%

Carer engagement in the hospital care of older people: an integrative literature review

Morrow¹,

Nicholson

2016

Int J Older People Nursing

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Section: Resultsmentioning

confidence: 97%

Carer engagement in the hospital care of older people: an integrative literature review

Morrow¹,

Nicholson

2016

Int J Older People Nursing

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“…Due to a feeling of a constant lack of time and resources, there was little going on for the patients, except standardized routines. Patient participation takes more time, “doing for” requires less time than “doing with.” This is in line with previous IC‐research, which states that when organizational conditions exert pressure on the work situation, care as a practical activity seems to be prioritized, at the cost of patient involvement . At the same time, some of the participants argued that IC is not a hotel, they are not there to be fixed, and the patients must also take responsibility for their own rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…Further, patient participation is shaped by organizational structures, the patients’ condition, resources, staff attitudes and support from relatives . Still, there is great variation in how patient participation is managed and experienced by patients and relatives . Thus, health‐care professionals in IC need to have extensive skills within geriatric rehabilitation including patient participation and communication techniques, taking into account the complex needs of older patients whose health status often fluctuates …”

Section: Introductionmentioning

confidence: 99%

Health‐care professionals’ experiences of patient participation among older patients in intermediate care—At the intersection between profession, market and bureaucracy

Kvæl

Bye

Bergland

2019

Health Expectations

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BackgroundPatient participation is a key concern in health care. Nevertheless, older patients often do not feel involved in their rehabilitation process. Research states that when organizational conditions exert pressure on the work situation, care as a mere technical activity seems to be prioritized by the health‐care staff, at the expense of patient involvement.ObjectiveThe aim of this article is to explore how health‐care professionals experience patient participation in IC services, and explain how they perform their clinical work balancing between the patient's needs, available resources and regulatory constraints.DesignUsing a framework of professional work and institutional logics, underpinned by critical realism, we conducted semi‐structured interviews with 18 health‐care professionals from three IC institutions.ResultsIC appears as an important service in the patient pathway for older people with a great potential for patient participation. However, health care staff may experience constraints that prohibit them from using professional discretion, which is perceived as a threat to patient participation. Further, they may adopt routines that simplify their interactions with patients. Our results call for more emphasis on an individualized rehabilitation process and a recognition that psychological and social aspects are critical for patient participation in IC.ConclusionPatients interact in the face of conflicting institutional priorities or protocols. The study adds important knowledge about the practice of patient participation in IC from a front‐line provider perspective. Underlying mechanisms are identified to understand and recommend how to facilitate patient participation at different levels in narrowing the gap between policy and clinical work in IC.

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“…Health professionals sometimes experience that decisions made by patients while in the hospital are not always welcomed by relatives (Rydeman et al., ). Research on decision‐making in family meetings suggests that family input and time may enhance the level of patient participation (Milte et al., ; Reed & Harding, ). Family meetings have been found to be helpful and much appreciated by patients and their family (Griffith, Brosnan, Lacey, Keeling, & Wilkinson, ; Reed & Harding, ) and are in line with person‐centred care with respect to taking the everyday life and functioning of patients and their family into account (Starfield, ).…”

Section: Discussionmentioning

confidence: 99%

User participation is a family matter: A multiple case study of the experiences of older, hospitalised people and their relatives

Nyborg

Danbolt

Kirkevold

2017

Journal of Clinical Nursing

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Aims and objectives: The purpose of this multiple case study was to compare and contrast older people's and their relatives' experiences of participation in decision-making processes regarding the planning of everyday life after discharge from hospital.Background: Internationally, patient involvement in health services is established to benefit patient health and to improve quality of the services. The literature shows that at hospital discharge, older people would benefit from better communication and more active participation of relatives in the discharge planning. Little research has been carried out on the experiences of patients and relatives as a family in this context, and even less has investigated their participation.Design: This study used a qualitative design with a comparative multicase approach.Participants were recruited from two hospitals in Norway using a purposive sampling strategy.Methods: Semi-structured interviews were conducted with five patients and with six of their relatives.Results: Three patterns of experiences were identified: contradicting experiences; consistent experiences of nonpreferred participation; similar, but separate experiences of user participation.Conclusions: User participation in the planning of everyday life following discharge appeared to be random and limited for both patients and their relatives, and conflicting for the families as a whole. The decision-making processes seemed to be limited to the hospital context and did not include the broader context of everyday life following discharge.Relevance to clinical practice: The results underscore the importance of taking a family perspective when caring for older people. Family meetings might be a useful tool to ensure systematic assessment and integration of the perspectives of both older people and their family in the planning of follow-up care.case study research, decision-making, family, hospital, older people, patient participation,This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. • User participation is a family matter when decisions made in hospital affect the family;• Older people and their relatives generally experience limited user participation;• Experiences of user participation among older people and their relatives may be conflicting;• Institutionalising participation of older patients and their relatives is necessary to improve this aspect of care.of patients' participation in hospital admission and discharge processes, it was found that next of kin were information providers and advocates for the patient during admission, and provided moral and practical support throughout stay (Dyrstad, Laugaland, & Storm, 2015). Studies that examined family participation in discharge processes also found that relatives were given wide-ranging roles, they struggled to gain influence, and they often acted as intermedi...

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Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

Cited by 31 publications

References 34 publications

Carer engagement in the hospital care of older people: an integrative literature review

Carer engagement in the hospital care of older people: an integrative literature review

Health‐care professionals’ experiences of patient participation among older patients in intermediate care—At the intersection between profession, market and bureaucracy

User participation is a family matter: A multiple case study of the experiences of older, hospitalised people and their relatives

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