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

Lucy Selman, Barbara Daveson, Melinda Smith, Bridget Johnston, Karen Ryan, R. Sean Morrison, Caty Pannell, Regina McQuillan, Susanne de Wolf-Linder, Steven Z Pantilat, Lara Klass, Diane E Meier, Charles Normand, Irene J Higginson

Research output: Contribution to journalArticle (Academic Journal)peer-review

7 Citations (Scopus)
259 Downloads (Pure)

Abstract

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. 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 staff, and other clinicians who cared for older adults with advanced disease, and field work. Data were analysed using directed thematic analysis.

Results: Analysis of 91 interviews and 340 hours 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. Specialist palliative care 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, and appropriate access to specialist palliative care. Findings have relevance for many high- and middle-income countries with a growing population of older patients with advanced disease.
Original languageEnglish
Pages (from-to)300-309
Number of pages10
JournalAge and Ageing
Volume46
Issue number2
Early online date3 Nov 2016
DOIs
Publication statusPublished - Mar 2017

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