Kiselev Joern, Suija Kadri, Oona Marje, Mellenthin Eva, Steinhagen-Thiessen Elisabeth
Geriatrics Research Group, Department for Aging and Technology, Charité Unversity Medicine, Berlin, DE.
Department of Family Medicine, Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Estonia, EE.
Int J Integr Care. 2018 Feb 28;18(1):12. doi: 10.5334/ijic.2517.
Patient involvement is a core component of an integrated care approach. While the benefits and prerequisites of patient involvement have been described in general and additionally for some target populations, little is known about the views and experiences of older people regarding this matter.
A study with a mixed-methods design was conducted to gain a better understanding about patient involvement in geriatric care. A questionnaire on shared decision-making was administered within a group of older adults in Germany. Additionally, 7 focus groups with health professionals and geriatric patients in Germany and Estonia were held to deepen the insight of the questionnaire and discussing experiences and barriers of patient involvement.
Older people without an actual medical problem expressed a significantly higher desire to participate in shared decisions than those requiring actual medical care. No significant differences could be found for the desire to be informed as part of the care process. No correlation between patients' desire and experiences on shared decision-making could be observed. In the focus groups, patients demanded a comprehensive and understandable information and education process while the health professionals' view was very task-specific. This conflict led to a loss of trust by the patients.
There is a gap between patients' and health professionals' views on patient involvement in older people. The involvement process should therefore be comprehensive and should take into account different levels of health literacy.
患者参与是综合护理方法的核心组成部分。虽然一般而言，以及针对某些特定目标人群，已经描述了患者参与的益处和前提条件，但对于老年人在此问题上的观点和经历却知之甚少。
开展了一项采用混合方法设计的研究，以更好地了解老年护理中的患者参与情况。在德国的一组老年人中发放了一份关于共同决策的问卷。此外，在德国和爱沙尼亚与卫生专业人员和老年患者举行了7次焦点小组讨论，以深化对问卷的理解，并讨论患者参与的经验和障碍。
没有实际医疗问题的老年人比那些需要实际医疗护理的老年人表达了更高的参与共同决策的意愿。在作为护理过程一部分而希望获得信息方面，未发现显著差异。未观察到患者的意愿与共同决策经验之间存在相关性。在焦点小组中，患者要求有一个全面且易于理解的信息和教育过程，而卫生专业人员的观点则非常针对具体任务。这种冲突导致患者失去信任。
在老年人患者参与方面，患者和卫生专业人员的观点存在差距。因此，参与过程应该全面，并应考虑到不同水平的健康素养。
