Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

Catherine Milte, Julie Ratcliffe, Owen Davies, Craig Whitehead, Stacey Masters, Maria Crotty

    Research output: Contribution to journalArticle

    16 Citations (Scopus)

    Abstract

    Background: Clinicians, older adults and caregivers frequently meet to make decisions around treatment and lifestyle during an acute hospital admission. Patient age, psychological status and health locus of control (HLC) influence patient preference for consultation involvement and information but overall, a shared-decision-making (SDM) approach is favoured. However, it is not known whether these characteristics and the presence of cognitive impairment influence SDM competency during family meetings. Objective: To describe meetings between older adults, caregivers and geriatricians in intermediate care and explore patient and meeting characteristics associated with a SDM communication style. Methods: Fifty-nine family meetings involving geriatricians, patients in an intermediate care setting following an acute hospital admission and their caregivers were rated using the OPTION system for measuring clinician SDM behaviour. The geriatric depression scale and multidimensional HLC scale were completed by patients. The mini-mental state exam (MMSE) assessed patient's level of cognitive impairment. Results: Meetings lasted 38 min (SD 13) and scored 41 (SD 17) of 100 on the OPTION scale. Nine (SD 2.2) topics were discussed during each meeting, and most were initiated by the geriatrician. Meeting length was an important determinant of OPTION score, with higher SDM competency displayed in longer meetings. Patient characteristics, including MMSE, HLC and depression did not explain SDM competency. Conclusion: Whilst SDM can be achieved during consultations frail older patients and their caregivers, an increased consultation time is a consequence of this approach.

    Original languageEnglish
    Pages (from-to)1030-1040
    Number of pages11
    JournalHealth Expectations
    Volume18
    Issue number5
    Early online date2015
    DOIs
    Publication statusPublished - 1 Oct 2015

    Keywords

    • Decision making
    • Frail elderly
    • Health services for aged
    • Physician-patient relations

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