Towards patient‐centred communication in the management of older patients' medications across transitions of care: A focused ethnographic study

Abstract

Background Communication about managing medications during transitions of care can be a challenging process for older patients since they often have complex medication regimens. Previous studies highlighted that links between communication breakdowns and medication incidents in older patients occur mainly at discharge or in the post‐discharge period. Little attention has been paid to exploring communication strategies facilitating patient‐centred medication communication at transitions of care from a discourse‐analytic perspective. Objectives To explore, through a discursive lens, strategies that enable patient‐centred medication communication at transitions of care. Design A focused ethnographic study was employed for this study. The study was reported according to the COREQ checklist. Methods Interviews, observations and focus groups were analysed utilising Critical Discourse Analysis and the Medication Communication Model following thematic analysis. Data collection was undertaken in eight wards across two metropolitan hospitals in Australia. Results Patient preferences and beliefs about medications were identified as important characteristics of patient‐centred communication. Strategies included empathetic talk prioritising patients' medication needs and preferences for medications; informative talk clarifying patients' concerns; and encouraging talk for enhancing shared decision‐making with older patients. Challenges relating to the use of these strategies included patients' hearing, speech or cognitive impairments, language barriers and absence of interpreters or family members during care transitions. Relevance to clinical practice To enhance medication communication, nurses, doctors and pharmacists should incorporate older patients' preferences, previous experiences and beliefs, and consider the challenges faced by patients across transitions. Strategies encouraging patients' contribution to decision‐making processes are crucial to patient‐centeredness in medication communication. Nurses need to engage in informative talk more frequently when administering the medications to ensure older patients' understanding of medications prescribed or altered in hospital settings.

Older patient participation in discharge medication communication: an observational study

“…The discharge context in acute care wards may entrench patient passivity. 14 Older patients report more satisfaction when discharge medication information is given in an environment of 'peace' and 'quiet' 37 , which was inconsistent with the noisy environments in our study. On the other hand, patient-related factors may have influenced passivity.…”

“…Overall, conversations tended to be monologues and conversation topics were overwhelming initiated by healthcare professionals; yet, our study showed the almost 70% of patients preferred an active role, thus it is not clear why patients were so passive? The discharge context in acute care wards may entrench patient passivity 14. Older patients report more satisfaction when discharge medication information is given in an environment of ‘peace’ and ‘quiet’37, which was inconsistent with the noisy environments in our study.…”

“…Older patients do not want to be overwhelmed by medication information on hospital admission, and desire information sharing when their health is improving and they are capable of participation. 14 Thus, a more tailored approach that does not occur only at discharge may facilitate more patient participation.…”

“…This can be due to traditional cultures of healthcare professionals leading care 28. Researchers suggest that another reason that pharmacist interactions tended to be rushed was due to the high flow of patients being discharged, and doctors and nurses had limited discharge medication communication with patients due to time constraints and multitasking 14. Thus, while healthcare professionals were initiating more topics for high-risk patients, there is opportunity for them to encourage more dialogue (ie, two-way communication).…”

“…Understanding patient participation in discharge medication communication is largely based on interview data rather than observation of actual practices 11 13. Some small-scale observational research has been conducted, providing an indication of how engaged older patients are in discharge medication communication and the factors influencing their participation 14–16. These observational studies provide rich accounts of human behaviour in its natural setting; a quantitative study with a larger sample size may compliment previous research by expanding on this evidence, confirming the practices of a larger population and allowing testing of relationships between factors.…”