Shared Decision Making with Acutely Hospitalized, Older Poly-Medicated Patients: A Mixed-Methods Study in an Emergency Department

Pia Keinicke Fabricius, Anissa Aharaz, Nina Thórný Stefánsdóttir, Morten Baltzer Houlind, Karina Dahl Steffensen, Ove Andersen and Jeanette Wassar Kirk
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Pia Keinicke Fabricius: Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
Anissa Aharaz: Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
Nina Thórný Stefánsdóttir: Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
Morten Baltzer Houlind: Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
Karina Dahl Steffensen: Center for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, 7100 Vejle, Denmark
Ove Andersen: Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
Jeanette Wassar Kirk: Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark

IJERPH, 2022, vol. 19, issue 11, 1-19

Abstract: 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.

Keywords: shared decision making; older patients; polypharmacy; mixed methods; emergency department (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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