How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA.
| Autor: | SELMAN, LUCY ELLEN, DAVESON, BARBARA A., SMITH, MELINDA, JOHNSTON, BRIDGET, RYAN, KAREN, MORRISON, R. SEAN, PANNELL, CATY, MCQUILLAN, REGINA, DE WOLF-LINDER, SUZANNE, PANTILAT, STEVEN Z., KLASS, LARA, MEIER, DIANE, NORMAND, CHARLES, HIGGINSON, IRENE J. |
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| Předmět: |
CAREGIVERS
COMMUNICATION CRITICAL care medicine DECISION making FOCUS groups HEALTH HEALTH services accessibility HOSPITAL care INTELLECT INTERVIEWING MEDICAL personnel PATIENT-professional relations METROPOLITAN areas SCIENTIFIC observation PALLIATIVE treatment PATIENTS RESEARCH funding HEALTH self-care SELF-efficacy INFORMATION resources ETHNOLOGY research QUALITATIVE research FIELD research THEMATIC analysis PATIENT-centered care DATA analysis software |
| Zdroj: | Age & Ageing; Mar2017, Vol. 46 Issue 2, p300-309, 10p, 1 Chart |
| Abstrakt: | Background: patient empowerment, through which patients become self-determining agents with some control over their health and healthcare, is a common theme across health policies globally. Most care for older people is in the acute setting, but there is little evidence to inform the delivery of empowering hospital care. Objective: we aimed to explore challenges to and facilitators of empowerment among older people with advanced disease in hospital, and the impact of palliative care. Methods: we conducted an ethnography in six hospitals in England, Ireland and the USA. The ethnography involved: interviews with patients aged ≥65, informal caregivers, specialist palliative care (SPC) staff and other clinicians who cared for older adults with advanced disease, and fieldwork. Data were analysed using directed thematic analysis. Results: analysis of 91 interviews and 340 h of observational data revealed substantial challenges to empowerment: poor communication and information provision, combined with routinised and fragmented inpatient care, restricted patients' self-efficacy, self-management, choice and decision-making. Information and knowledge were often necessary for empowerment, but not sufficient: empowerment depended on patient-centredness being enacted at an organisational and staff level. SPC facilitated empowerment by prioritising patient-centred care, tailored communication and information provision, and the support of other clinicians. Conclusions: empowering older people in the acute setting requires changes throughout the health system. Facilitators of empowerment include excellent staff-patient communication, patient-centred, relational care, an organisational focus on patient experience rather than throughput, and appropriate access to SPC. Findings have relevance for many high- and middle-income countries with a growing population of older patients with advanced disease. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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