TY - JOUR

T1 - Shared Decision Making with Acutely Hospitalized, Older Poly-Medicated Patients

T2 - A Mixed-Methods Study in an Emergency Department

AU - Fabricius, Pia Keinicke

AU - Aharaz, Anissa

AU - Stefánsdóttir, Nina Thórný

AU - Houlind, Morten Baltzer

AU - Steffensen, Karina Dahl

AU - Andersen, Ove

AU - Kirk, Jeanette Wassar

N1 - Funding Information: Funding: Funding was provided by Velux Foundation grant number (00021736): https://veluxfound ations.dk/da/forskning/aldringsforskning (accessed on 1 March 2020). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

PY - 2022

Y1 - 2022

N2 - Shared decision making (SDM) about medicine with older poly-medicated patients is vital to improving adherence and preventing medication-related hospital admissions, but it is difficult to achieve in practice. This study’s primary aim was to provide insight into the extent of SDM in medication decisions in the Emergency Department (ED) and to compare how it aligns with older poly-medicated patients’ preferences and needs. We applied a mixed-methods design to investigate SDM in medication decisions from two perspectives: (1) observational measurements with the observing patient involvement (OPTION 5) instrument of healthcare professionals’ SDM behavior in medication decisions and (2) semi-structured interviews with older poly-medicated patients. A convergent parallel analysis was performed. Sixty-five observations and fourteen interviews revealed four overall themes: (1) a low degree of SDM about medication, (2) a variation in the pro-active and non-active patients approach to conversations about medicine, (3) no information on side effects, and (4) a preference for medication reduction. The lack of SDM with older patients in the ED may increase inequality in health. Patients with low health literacy are at risk of safety threats, nonadherence, and preventable re-admissions. Therefore, healthcare professionals should systematically investigate older poly-medicated patients’ preferences and discuss the side effects and the possibility of reducing harmful medicine.

AB - Shared decision making (SDM) about medicine with older poly-medicated patients is vital to improving adherence and preventing medication-related hospital admissions, but it is difficult to achieve in practice. This study’s primary aim was to provide insight into the extent of SDM in medication decisions in the Emergency Department (ED) and to compare how it aligns with older poly-medicated patients’ preferences and needs. We applied a mixed-methods design to investigate SDM in medication decisions from two perspectives: (1) observational measurements with the observing patient involvement (OPTION 5) instrument of healthcare professionals’ SDM behavior in medication decisions and (2) semi-structured interviews with older poly-medicated patients. A convergent parallel analysis was performed. Sixty-five observations and fourteen interviews revealed four overall themes: (1) a low degree of SDM about medication, (2) a variation in the pro-active and non-active patients approach to conversations about medicine, (3) no information on side effects, and (4) a preference for medication reduction. The lack of SDM with older patients in the ED may increase inequality in health. Patients with low health literacy are at risk of safety threats, nonadherence, and preventable re-admissions. Therefore, healthcare professionals should systematically investigate older poly-medicated patients’ preferences and discuss the side effects and the possibility of reducing harmful medicine.

KW - emergency department

KW - mixed methods

KW - older patients

KW - polypharmacy

KW - shared decision making

U2 - 10.3390/ijerph19116429

DO - 10.3390/ijerph19116429

M3 - Journal article

C2 - 35682021

AN - SCOPUS:85130843882

VL - 19

JO - International Journal of Environmental Research and Public Health

JF - International Journal of Environmental Research and Public Health

SN - 1661-7827

IS - 11

M1 - 6429

ER -