School of Psychology, The University of Adelaide, Adelaide, Australia Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia.
Scand J Caring Sci; 2013; 27; 3–12
Discharge-planning for long-term care needs: the values and priorities of older people, their younger relatives and health professionals
Discharge-planning decisions about long-term care (LTC) can be difficult and distressing for older people, families and discharge-planning health professionals. Retrospective research suggests that despite good intentions and a shared focus on the best interests of the older person, stakeholders may hold very different values about good outcomes and how to decide them. We aimed to compare the opinions and values of frail elders living at home, younger relatives and health professionals experienced in discharge-planning, prospectively: before, not after, a LTC decision. We interviewed three types of stakeholders (10 older people, 8 relatives and 18 health professionals) using a hypothetical vignette about a frail elder leaving hospital. In a mixed methods design, we quantitatively compared the discharge plans and decision-makers that stakeholders suggested, and qualitatively analysed the 36 interview transcripts for participants’ articulation of underlying values during these discussions. Older participants often suggested safe restrictive options (residential care, proxy decision-making) for the hypothetical frail elder, while advocating autonomy for themselves. Younger people generally endorsed autonomous decision-making and less restrictive discharge options especially if the elder was mentally competent, but reported difficult ethical tensions between safety and autonomy. Individual personality and preferences, mental capacity, and the importance of personal care in supporting autonomy were central themes consistent with the Ecological Theory of Aging. Accordingly, discharge planners can usefully articulate the balance of safety and autonomy, conceptualizing home care as maintaining independence rather than accepting dependence. Ethical training should incorporate sophisticated models of practice specifying both psychological and physical safety as components of beneficence. Few elders adopt a consumer approach to LTC: health professionals can encourage mid-life adults to consider later care needs when planning for retirement.
"The spouses had never visited LTC facilities. When faced with placement, they tended to make hasty decisions, which could be one of the reasons for their lack of information on LTC facilities
[14,25]. The results showed that when faced with making placement decisions, spouses required the intervention of relevant consultation services. "
[Show abstract][Hide abstract] ABSTRACT: The aim of this research was to investigate factors affecting different family members' decisions regarding the placement of relatives in long-term car (LTC) facilities in Taiwan. The objective was to investigate the correlations between family members' personal traits, the living conditions of residents in the LTC facilities, and family members' experiences with LTC facilities.
This study selected family members visiting residents in LTC facilities as research subjects and used a structured questionnaire to perform face-to-face interviews. This study used nonlinear canonical correlation analysis (OVERALS) to categorize the decision-making factors affecting family members' choices of LTC facilities.
The results showed that when making decisions about the placement of family members, spouses chose facilities according to their own life experiences, children considered medical treatment convenience, grandchildren preferred to collect relevant information on facilities, and other relatives preferred to decide based on introductions from government departments.
These results help clarify how different family roles affect decision-making processes regarding the choice of LTC facilities. In particular, spouses and female relatives require an interventional service mechanism that provides consultation or referral information.
BMC Health Services Research 01/2014; 14(1):21. DOI:10.1186/1472-6963-14-21 · 1.71 Impact Factor
"According to a number of studies, 80% of all primary-care consultations are related to chronic diseases, and 60% of hospitalizations are associated with the treatment of chronic diseases or their complications . Studies conducted in Australia, Canada, Germany, Netherlands, New Zealand, the UK and the USA have shown that care for the chronically ill should be based on an information infrastructure focusing on the quality of care   . "
[Show abstract][Hide abstract] ABSTRACT: Background. Patients with at least one chronic disease requiring regular contact with their GP, additional tests and systematic use of medicines constitute one of the challenges for the future of primary medical care.
Objectives. To evaluate correlations between patients' characteristics and their assessments of the quality of health care and to identify the primary factors influencing the quality of care for chronically ill patients.
Material and Methods. The sample for the current analysis included 232 chronically ill adult patients of primary care clinics in Poland. The patients' opinions regarding subjective and objective examinations, their participation in clinical decision-making processes, psychosocial factors, contact with the doctor in emergency situations and confidence in the doctor were investigated.
Results. The strongest correlations defining the quality of care for the chronically ill were identified as the occur-rence of hypertension (0.248, p < 0.001), the patient's gender (0.271, p < 0.001), the patient's level of education (0.169, p < 0.01) and the patient's age (0.155, p = 0.018). The results of the ANOVA test were statistically significant (p < 0.05) for the occurrence of myocardial infarction, hypertension, type 2 diabetes, psoriasis, multiple sclerosis, the doctor's gender, the patient's gender, age and education.
Conclusions. The areas that the participants gave the highest ratings to are subjective and objective examinations, kindness and willingness to help. The strongest correlations between high assessments of the quality of care pro-vided for chronically ill patients at primary care clinics were observed in the following variables: gender, age, level of education, frequency of visits, therapy conducted by a doctor at a specialist clinic, arterial hypertension, COPD and/or myocardial infarction (Adv Clin Exp Med 2013, 22, 4).
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