1
|
Jang SG, Ock M, Kim S. Qualitative Comparison of Perceptions Regarding Patient Engagement for Patient Safety by Physicians, Nurses, and Patients. Patient Prefer Adherence 2024; 18:1065-1075. [PMID: 38854478 PMCID: PMC11162203 DOI: 10.2147/ppa.s456050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/23/2024] [Indexed: 06/11/2024] Open
Abstract
Purpose Patient engagement in ensuring patient safety is widely acknowledged, there is still a need to explore how perceptions of patient engagement vary among different stakeholders within the healthcare system. We aimed to compare the perceptions regarding patient engagement for patient safety among physicians, nurses, and patients by exploring the perspectives. Patients and Methods A qualitative study, comprising three focus group discussions (six to eight people each), was conducted in South Korea. Physicians and nurses who worked at the general hospital level or higher, and patients who had been hospitalized for more than 24 hours, were included. Researchers analyzed the transcripts, and a content analysis was performed to describe influencing elements of patient engagement for patient safety. A word cloud was created through keyword analysis of the transcripts. Results Based on 479 coded data, three categories and eight sub-categories were derived. The first moment of patient engagement was viewed as the choice of medical institutions. Reputation occupied a large part in the hospital selection for all participants, but they did not know about or use the national hospital evaluation data. Participants said that continuous patient engagement, such as the patient's active questioning attitude, guardian's cooperation, sufficient medical personnel, and patient safety education was required during treatment. However, it was said that patient engagement was ignored after patient safety incidents occurred. They mentioned that they were emotional and busy arguing for their own positions, and that it was difficult to use a medical dispute resolution method in practice. In the word cloud by group, fall, explanation, hospital, and patient were common words. Conclusion All three groups agreed on the importance of patient engagement for patient safety but differed in its influencing factors. Efforts should be made to reduce the difference between the three groups on how to involve patients for patient safety.
Collapse
Affiliation(s)
| | - Minsu Ock
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Soyoon Kim
- Department of Medical Law and Ethics, Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
2
|
Mehta A, Chai E. There Are No Shortcuts: Eliciting Explicit Values to Provide Goal-Concordant Care. J Palliat Med 2022; 25:1754-1755. [PMID: 36472523 DOI: 10.1089/jpm.2022.0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ankita Mehta
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily Chai
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
3
|
Gazarian P, Gupta A, Reich A, Perez S, Semco R, Prigerson H, Ashana D, Dey T, Carlston D, Cooper Z, Weissman J, Ladin K. Educational Resources and Self-Management Support to Engage Patients in Advance Care Planning: An Interpretation of Current Practice in the US. Am J Hosp Palliat Care 2022; 39:934-944. [PMID: 35077259 DOI: 10.1177/10499091211064834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Educational resources and decision aids help patients, their care partners and health care providers prepare for and confidently engage in Advance Care Planning (ACP). Incorporating ACP resources as part of a self-management approach may lead to fuller engagement with ACP beyond identifying a surrogate decision-maker, towards supporting a person to identify their values and goals and to communicate them with their care partners and health care providers. OBJECTIVE To examine the use of educational resources and decision aids to support self-management of ACP in 11 health systems across the US. METHODS This study was a qualitative interview study examining barriers and facilitators to ACP. Guided by interpretative description and the chronic care model, we sought to describe how health care stakeholders (clinicians and administrators) and patients use ACP resources to support engagement with ACP. RESULTS 274 health care stakeholders were interviewed, and 7 patient focus groups were conducted across 11 health systems. The majority of participants reported using resources to support completion of preference documentation, with fewer participants using resources that promote more engagement in ACP. ACP resources were reported as valuable in preparing for and complementing a complex, interpersonal, and interprofessional process. Barriers to using resources included a lack of a defined workflow and time. CONCLUSION Our data suggest that ACP resources that promote engagement are valued but under-utilized in practice. The use of ACP resources with an inter-professional team and a self-management approach is a promising strategy to mitigate the barriers of ACP implementation while improving engagement in ACP.
Collapse
Affiliation(s)
- Priscilla Gazarian
- Center for Surgery and Public Health, 1861Brigham and Women's Hospital, Boston, MA, USA.,Department of Nursing, 1851University of Massachusetts Boston, Boston, MA, USA
| | - Avni Gupta
- Department of Public Health Policy and Management, 5894New York University, New York, NY, USA
| | - Amanda Reich
- Center for Surgery and Public Health, 1861Brigham and Women's Hospital, Boston, MA, USA
| | - Stephen Perez
- Center for Surgery and Public Health, 1861Brigham and Women's Hospital, Boston, MA, USA
| | - Robert Semco
- Center for Surgery and Public Health, 1861Brigham and Women's Hospital, Boston, MA, USA
| | - Holly Prigerson
- Center for Research on the End-of-Life, 12295Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - Deepshikha Ashana
- Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, 12277Duke University School of Medicine, Durham, NC, USA
| | - Tanujit Dey
- Center for Surgery and Public Health, 1861Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Carlston
- Research on Ethics, Aging, and Community Health (REACH Lab), 1810Tufts University, Medford, MA, USA
| | - Zara Cooper
- Center for Surgery and Public Health, 1861Brigham and Women's Hospital, Boston, MA, USA
| | - Joel Weissman
- Center for Surgery and Public Health, 1861Brigham and Women's Hospital, Boston, MA, USA
| | - Keren Ladin
- Department of Occupational Therapy and Community Health, 1810Tufts University, Medford, MA, USA
| |
Collapse
|
4
|
Kaasalainen S, Sussman T, Nicula M, Lawrence J, Thompson G, McCleary L, Wickson-Griffiths A, You JJ. Evaluating the Implementation of the Conversation Starter Kit in Long Term Care. SAGE Open Nurs 2021; 7:23779608211051824. [PMID: 34746381 PMCID: PMC8564126 DOI: 10.1177/23779608211051824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Advance care planning can improve the quality of life for residents in
long-term care homes and reduce stress for families. However, care home
staff and families often lack knowledge about advance care planning, making
it especially difficult for residents with dementia to communicate their
care plan wishes. A Conversation Starter Kit may increase advance care
planning awareness among staff and families. Objectives This study evaluated an advance care planning intervention, the Conversation
Starter Kit booklet, for use in long term care homes. Methods Data were collected at three long-term care homes in southern Ontario. We
collected data from 55 residents who were able to make decisions on their
own paired with 11 family members of these residents. We also collected data
from 24 family members of residents who were unable to make decisions on
their own. This study used a quasi-experimental, one group pre/post design.
Quantitative surveys were administered before and after a three-month
advance care planning intervention. An additional structured interview was
completed at the end of the intervention period, which included both closed
and open-ended questions to assess perceptions about the booklet's use or
non-use. Results Residents reported more engagement in advance care planning after completing
the Conversation Starter Kit booklet, particularly related to asking
questions to health care providers about health care decisions. Family
members reported feeling very certain that they would be able to make
decisions on behalf of the resident but felt less certain after completing
the booklet, implying the booklet raised their awareness of the types of
decisions they might need to make, hopefully prompting them to be more
prepared for decisions in the future. Conclusions An advance care planning intervention – The Conversation Starter Kit booklet
- appears acceptable and easy to use for residents and family
members/friends in long-term care and can improve resident engagement in
advance care planning. Although using the booklet may decrease efficacy for
decision making among family members of long-term care residents, it may
highlight the importance of more actionable engagement in advance care
planning among residents, their families/friends, and staff.
Collapse
Affiliation(s)
| | - Tamara Sussman
- Faculty of Arts, School of Social Work, McGill University, Montreal, QC, Canada
| | - Maria Nicula
- Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | - Jack Lawrence
- Faculty of Arts, School of Social Work, McGill University, Montreal, QC, Canada
| | - Genevieve Thompson
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba,Winnipeg, MB, Canada
| | - Lynn McCleary
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | | | - John J You
- Division of General Internal and Hospitalist Medicine, Credit Valley Hospital, Mississauga, Ontario, Canada
| | | |
Collapse
|
5
|
Sussman T, Kaasalainen S, Lawrence J, Hunter PV, Bourgeois-Guerin V, Howard M. Using a self-directed workbook to support advance care planning with long term care home residents. BMC Palliat Care 2021; 20:121. [PMID: 34325675 PMCID: PMC8323265 DOI: 10.1186/s12904-021-00815-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While advance care planning (ACP) has been shown to improve the quality of end-of-life (EOL) communication and palliative care, it is rarely practiced in long term care (LTC) homes, where staff time to support the process is limited. This study examines the potential of a publicly available self-directed ACP workbook distributed to LTC residents to encourage ACP reflection and communication. METHODS Recruitment took place across three LTC homes, between June 2018 and July 2019. To be eligible, residents had to have medical stability, cognitive capacity, and English literacy. The study employed a mixed methods concurrent design using the combination of ranked (quantitative) and open (qualitative) workbook responses to examine documented care preferences and ACP reflections and communications. RESULTS 58 residents initially agreed to participate in the study of which 44 completed self-directed ACP workbooks. Our combined quantitative and qualitative results suggested that the workbooks supported the elicitation of a range of resident care preferences of relevance for EOL care planning and decision making. For example, ranked data highlighted that most residents want to remain involved in decisions pertaining to their care (70%), even though less than half expect their wishes to be applied without discretion (48%). Ranked data further revealed many residents value quality of life over quantity of life (55%) but a sizable minority are concerned they will not receive enough care at EOL (20%). Open comments affirmed and expanded on ranked data by capturing care preferences not explored in the ranked data such as preferences around spiritual care and post mortem planning. Analysis of all open comments also suggested that while the workbook elicited many reflections that could be readily communicated to family/friends or staff, evidence that conversations had occurred was less evident in recorded workbook responses. CONCLUSIONS ACP workbooks may be useful for supporting the elicitation of resident care preferences and concerns in LTC. Developing follow up protocols wherein residents are supported in communicating their workbook responses to families/friends and staff may be a critical next step in improving ACP engagement in LTC. Such protocols would require staff training and an organizational culture that empowers staff at all levels to engage in follow up conversations with residents.
Collapse
Affiliation(s)
- Tamara Sussman
- McGill University School of Social Work, 3506 University St. #300, Montreal, QC, H3A 2A7, Canada.
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, 2J20L8S 4K1, Canada
| | - Jack Lawrence
- McGill University School of Social Work, 3506 University St. #300, Montreal, QC, H3A 2A7, Canada
| | - Paulette V Hunter
- University of Saskatchewan, St Thomas More College, Psychology, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada
| | - Valerie Bourgeois-Guerin
- Department of Psychology, University of Quebec in Montreal, 100 Sherbrook St West, Montreal, QC, H3C 3P8, Canada
| | - Michelle Howard
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th floor, Hamilton, On, L8P 1H6, Canada
| |
Collapse
|
6
|
Makoul G. Patient-centered innovation: Lessons learned. PATIENT EDUCATION AND COUNSELING 2021; 104:677-678. [PMID: 33766403 DOI: 10.1016/j.pec.2021.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Gregory Makoul
- NRC Health, Madison CT and Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|