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

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  • Pia Keinicke Fabricius

    (Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
    Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark)

  • Anissa Aharaz

    (Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
    The Capital Region Pharmacy, 2730 Herlev, 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
    The Capital Region Pharmacy, 2730 Herlev, Denmark
    Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark)

  • Karina Dahl Steffensen

    (Center for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, 7100 Vejle, Denmark
    Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark)

  • Ove Andersen

    (Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
    Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
    Emergency Department, 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
    Department of Public Health, Nursing, Aarhus University, 8000 Aarhus, Denmark)

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.

Suggested Citation

  • Pia Keinicke Fabricius & Anissa Aharaz & Nina Thórný Stefánsdóttir & Morten Baltzer Houlind & Karina Dahl Steffensen & Ove Andersen & Jeanette Wassar Kirk, 2022. "Shared Decision Making with Acutely Hospitalized, Older Poly-Medicated Patients: A Mixed-Methods Study in an Emergency Department," IJERPH, MDPI, vol. 19(11), pages 1-19, May.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:11:p:6429-:d:824054
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    References listed on IDEAS

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    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
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