Resident and informal caregiver involvement in medication-related decision-making and the medicines’ pathway in nursing homes: experiences and perceived opportunities of healthcare professionals

Abstract

Background Person-centered care has been shown to be beneficial for nursing home residents. The know-how and attitude of healthcare professionals, however, can make its implementation difficult. Also, research on person-centered care with regard to medication decision-making and the medicines’ pathway in nursing homes is lacking. This study aimed to provide an understanding of healthcare professionals’ attitudes and perspectives on current resident and informal caregiver involvement in medication decision-making and the medicines’ pathway in nursing homes. Methods A qualitative, explorative study using semi-structured interviews with a sample of 25 healthcare professionals from four different nursing homes was performed. Interview transcripts were analyzed by means of an inductive thematic framework. Results Three overarching domains were identified: 1) features of, 2) drivers and barriers for, and 3) perceived consequences of resident and informal caregiver involvement in medication decision-making and the medicines’ pathway. Involvement was mainly initiated by residents and informal caregivers themselves, pointing towards information and participation needs among both groups. Nevertheless, actions of healthcare professionals towards resident and informal caregiver involvement were mainly reactive and fragmentary. Their actions were influenced by the perception of residents and informal caregivers’ desire and capabilities to be involved, the perception of their own professional role, but also by organizational factors such as the nursing home’s philosophy. Furthermore, organizational concerns tempered the motivation to provide residents and informal caregivers with more medication-related responsibilities. Conclusions Resident and informal caregiver involvement in medication decision-making and the medicines’ pathway remains limited in nursing homes. Information and participation needs of residents and informal caregivers were not fully acknowledged by healthcare professionals. As such, we can conclude that there is a need for initiatives, both on an individual and on an organizational level, to create and improve awareness on opportunities to improve resident and informal caregiver involvement in medication decision-making and the medicines’ pathway.

Person-centred medicine in the care home setting: development of a complex intervention

“…We found that the intervention focus on resident and relative involvement was in alignment with the organisational and individual professional values articulated during the development process. Organisational values have been identified as an important influencing factor in the realisation of resident and relative involvement and shared decision-making [ 22 , 60 ]. However, solely having a general focus on involvement is not sufficient to ensure actual involvement [ 22 ], and, in our study, the HCPs emphasised that involvement takes time and needs to be prioritized to occur more systematically.…”

Barriers and enablers towards benzodiazepine-receptor agonists deprescribing in nursing homes: A qualitative study of stakeholder groups

“…This should be done with all stakeholders' involvement, including NH management, and should guarantee a supportive organizational culture, which is of major impact. 33 , 34 Providing audit and feedback on BZRA use and deprescribing might also ensure that BZRA deprescribing remains an institutional priority.…”

“…HCPs believed that NHRs' involvement would prevent potential disagreements and increase NHRs' autonomy, but could also decrease the quality and safety of medication use. 34 A recent qualitative study analyzed barriers and enablers of older adults initiating deprescribing conversation. 39 They mainly reported barriers and enablers similar to our results such as a low self-efficacy, lack of knowledge and communication, and poor resources access.…”

Using Shared Decision-Making Resources in Long-Term Care: a Qualitative Study

“…( 1 , 3 , 4 ) Qualitative studies have demonstrated potential for improvement in SDM in LTC ( 5 ) including in the context of medication use. ( 6 ) While residents may have different levels of willingness to participate in medication decisions, they should be given the opportunity to engage in SDM. ( 7 ) Strategies to increase SDM for medication decisions may include providing residents and health-care providers with SDM resources such as decision aids, educational materials, or use of “what matters most”.…”