Department for Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Institutt for helsevitenskap, NTNU i Ålesund, Ålesund, Norway.
Department of Public Health and Nursing, Trondheim, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Institutt for samfunnsmedisin og sykepleie, NTNU, Øya Helsehus, Mauritz Hansens gate 2, Trondheim, Norway.
BMC Geriatr. 2021 Apr 13;21(1):242. doi: 10.1186/s12877-021-02184-z.
Active patients lie at the heart of integrated care. Although interventions to increase the participation of older patients in care planning are being implemented in several countries, there is a lack of knowledge about the interactions involved and how they are experienced by older patients with multimorbidity. We explore this issue in the context of care-planning meetings within Norwegian municipal health services.
This qualitative study drew on direct observations of ten care-planning meetings and an interview with each patient right after the meeting. Following a stepwise-deductive induction approach, the analysis began inductively and then considered the interactions through the lens of game theory.
The care-planning interactions were influenced by uncertainty about the course of the disease and how to plan service delivery. In terms derived from game theory, the imaginary and unpredictable player 'Nature' generated uncertainty in the 'game' of care planning. The 'players' assessed this uncertainty differently, leading to three patterns of game. 1) In the 'game of chance', patients viewed future events as random and uncontrollable; they felt outmatched by the opponent Nature and became passive in their decision-making. 2) In the 'competitive game', participants positioned themselves on two opposing sides, one side perceiving Nature as a significant threat and the other assigning it little importance. The two sides negotiated about how to accommodate uncertainty, and the level of patient participation varied. 3) In the 'coordination game', all participants were aligned, either in viewing themselves as teammates against Nature or in ascribing little importance to it. The level of patient participation was high.
In care planning meetings, the level of patient participation may partly be associated with how the various actors appraise and respond to uncertainty. Dialogue on uncertainty in care-planning interventions could help to increase patient participation.
积极参与的患者是整合照护的核心。尽管一些国家正在实施干预措施，以提高老年患者参与照护计划的程度，但对于涉及的相互作用以及患有多种疾病的老年患者的体验，我们知之甚少。我们在挪威市立卫生服务机构的照护计划会议背景下探讨了这一问题。
本定性研究基于对十次照护计划会议的直接观察以及会后对每位患者的访谈。采用逐步演绎归纳方法，分析首先是从归纳开始，然后从博弈论的角度考虑相互作用。
照护计划的相互作用受到对疾病进程和服务提供计划的不确定性的影响。根据博弈论衍生的术语，想象中的、不可预测的“自然”玩家在照护计划的“游戏”中产生了不确定性。“玩家”对这种不确定性有不同的评估，导致了三种游戏模式。1）在“机会游戏”中，患者认为未来的事件是随机且不可控的；他们觉得自己在对手“自然”面前处于劣势，在决策过程中变得被动。2）在“竞争游戏”中，参与者站在两个对立的立场上，一方认为“自然”是一个重大威胁，另一方则认为它不重要。双方就如何应对不确定性进行协商，患者的参与程度各不相同。3）在“协调游戏”中，所有参与者都站在同一立场，要么将自己视为对抗“自然”的队友，要么认为它不重要。患者的参与程度很高。
在照护计划会议中，患者的参与程度可能部分与各参与者如何评估和应对不确定性有关。在照护计划干预中讨论不确定性，可能有助于提高患者的参与程度。
