A comprehensive experience-based framework of actionable priorities to enhance Canada's health and social care system: discussions with older persons, clinicians, managers, and decision-makers using nominal group technique.

BACKGROUND

Existing frameworks of older persons' experiences in health and social care systems are usually based on single stakeholder perspectives and focused on limited aspects that are independent from one another. This study aimed to describe such experiences from the perspective of diverse stakeholders and develop a comprehensive experience-based framework for actionable priorities to enhance Canada's health and social care system.

METHODS

We adapted a nominal group technique with a qualitative approach. We formed four groups of stakeholders (4 older persons, 7 clinicians, 5 managers, 4 decision-makers) in the province of Quebec. First, participants individually completed a questionnaire to rank the six domains of an international set of metrics of quality of care for older persons in terms of their importance. Then, we conducted a remote discussion with each stakeholder group, obtained consensus on the priority domains, and explored personal/professional experiences explaining prioritization processes and what changes are needed. An inductive-deductive thematic analysis was conducted to develop a framework for actionable health and social care priorities.

RESULTS

The framework included six key categories revolving around a core category of 'health equity'. (1) 'Access to services and care' focused on improved accessibility of healthcare navigators, primary and home care services, and end-of life care. (2) 'Respect for older persons' involved individuality and uniqueness, daily needs, advocacy in defence of vulnerability, and decision-making valuing care preferences. (3) 'Involvement of family and friends' encompassed formal recognition, responsibilities, and trajectories associated with caregiving. (4) 'Communication and education' consisted of adaptive communication between older persons, caregivers, and professionals and societal-level education and awareness-raising. (5) 'Coordination and integration of care' comprised health and social services organization, cross-sectoral approaches, and interdisciplinary collaboration. (6) 'Responsiveness to evolving needs' of older persons involved timely response to health transitions and promoting holistic approaches.

CONCLUSIONS

This study illustrates the complex challenges of caring for older persons. The framework suggests several areas for improvement in care practices and policies for older persons and caregivers. Proposed intervention targets include public healthcare system navigators, standardized goals of care practices respecting persons' wishes, formal recognition of caregiver contributions, society-level education, cross-sectoral initiatives, and holistic approaches.