A qualitative study of patient-centered goal-setting in geriatric rehabilitation: patient and professional perspectives

Objective: To characterize how rehabilitation goals of older patients change over time and to explore professionals’ attitudes toward patient-centered goal-setting and their perspectives on rehabilitation goals. Design: Qualitative interview study. Setting: Three geriatric rehabilitation centers. Subjects: Ten patients (aged ⩾ 80), who had recently received inpatient geriatric rehabilitation, and seven professionals were purposively recruited. Methods: Semi-structured interviews. Patients were interviewed in the third or fourth week after discharge from inpatient rehabilitation, to reflect on their inpatient goals and to investigate long-term goals now that they were at home. A thematic analysis was performed. Results: During inpatient rehabilitation, participants’ main goals were regaining independence in self-care activities and going home. Post-discharge, patients were not at their baseline functioning level. Rehabilitation goals appeared to shift over time, and once at home, patients formulated more ambitious rehabilitation goals that were related to regaining full independence and being able to perform activities. Although professionals thought goal-setting together with the patient is important, they also stated that older individuals often are either unable to formulate goals or they set unrealistic ones. In addition, professionals indicated that goals have to be related to discharge criteria, such as performing basic self-care activities, and rehabilitation revolves around getting patients ready for discharge. Conclusion: During inpatient rehabilitation, patient goals are related to going home. After discharge, patients have ambitious goals, related to their premorbid functioning level. Rehabilitation services should distinguish between goals that are important while patients are inpatient and goals that are important after discharge.

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The meanings older people give to their rehabilitation experience

Ageing and Society ◽

10.1017/s0144686x06005113 ◽

2006 ◽

Vol 27 (1) ◽

pp. 147-164 ◽

Cited By ~ 9

Author(s):

MARJO WALLIN ◽

ULLA TALVITIE ◽

MIMA CATTAN ◽

SIRKKA-LIISA KARPPI

Keyword(s):

Older Adults ◽

Older People ◽

Everyday Life ◽

Qualitative Method ◽

Inpatient Rehabilitation ◽

Heterogeneous Group ◽

Geriatric Rehabilitation ◽

Structured Interviews ◽

Everyday Living ◽

At Home

Promoting older people's ability to manage at home is important both for themselves and for society, but few studies have explored whether geriatric rehabilitation actually meets the needs of this heterogeneous group. The purpose of this study was to investigate the meanings that older adults attribute to their geriatric rehabilitation experiences. A group of 27 older adults in inpatient rehabilitation were interviewed during the programme and after returning home. Semi-structured interviews were analysed using a qualitative method, which identified three categories of meaning. In the category ‘sense of confidence with everyday life’, rehabilitation was perceived as facilitating everyday living at home; in the category ‘sense of vacation’, rehabilitation was seen as a means of getting away from normal life and enjoying oneself; and in the category ‘sense of disappointment in the rehabilitation programme’, the participants expressed frustration with the limited opportunities to participate in the planning of their rehabilitation, and with the mismatch between the offered programme and what was needed. To promote older people's autonomy and to enhance their ability to live at home, professionals must involve their clients to a greater extent in the planning of the rehabilitation than is currently the case, and also individualise the rehabilitation regimen.

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Growth over time from experiences at home and child care

PsycEXTRA Dataset ◽

10.1037/e511912008-001 ◽

2008 ◽

Author(s):

Isabelle Chang

Keyword(s):

Child Care ◽

Over Time ◽

At Home

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A patient-centered mobile intervention to promote self-management and improve patient outcomes in chronic heart failure: The ManageHF4Life trial (Preprint)

10.2196/preprints.26185 ◽

2020 ◽

Author(s):

Michael P. Dorsch ◽

Karen B. Farris ◽

Brigid E. Rowell ◽

Scott L. Hummel ◽

Todd M. Koelling

Keyword(s):

Heart Failure ◽

Mobile Application ◽

Controlled Trial ◽

Intervention Group ◽

Self Care ◽

Self Management ◽

Control Group ◽

Patient Centered ◽

Self Monitoring ◽

Heart Failure Questionnaire

BACKGROUND Successful management of heart failure (HF) involves guideline based medical therapy as well as self-care behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. OBJECTIVE Evaluate the effectiveness of a mobile application intervention that enhances self-monitoring on health-related quality of life, self-management, and reduces HF readmissions. METHODS A single-center randomized controlled trial was performed. Patients greater than 45 years of age and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group used a mobile application (App). The intervention prompted daily self-monitoring and promoted self-management. The control group (No App) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire and recurrent HF admissions. RESULTS Eighty-three patients were enrolled and completed all baseline assessments. Baseline characteristics were similar between groups with the exception of HF etiology. The App group had a reduced MLHFQ at 6 weeks (37.5 ± 3.5 vs. 48.2 ± 3.7, P=0.039) but not at 12 weeks (44.2 ± 4 vs. 45.9 ± 4, P=0.778) compared to No App. There was no effect of the App on the SCHFI at 6 or 12 weeks. The time to first HF admission was not statistically different between the App versus No App groups (HR 0.89, 95% CI 0.39-2.02, P=0.781) over 12 weeks. CONCLUSIONS The mobile application intervention improved MLHFQ at 6 weeks, but did not sustain its effects at 12 weeks. No effect was seen on HF self-care. Further research is needed to enhance engagement in the application for a longer period of time and to determine if the application can reduce HF admissions in a larger study. CLINICALTRIAL NCT03149510

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Closing the Loop in Computer Agent/Patient Communication

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181320641165 ◽

2020 ◽

Vol 64 (1) ◽

pp. 711-715

Keyword(s):

Older Adults ◽

Best Practice ◽

Self Care ◽

Effective Teacher ◽

Care Providers ◽

Conversational Agents ◽

Patient Centered ◽

Face To Face ◽

Communication Techniques ◽

Improve Instruction

While patient-centered communication supports patient self-care, providers rarely have enough time to consistently use patient- centered communication techniques. Technology has potential to support patient-centered communication, but frequently older adults prefer face-to-face communication with providers. Conversational agents (CAs) may support provider communication with older adults by emulating best practices from face-to-face communication. We investigated older adults’ response to a prototype CA communication system that served as a virtual provider and presented medication instructions using teachback, a recommended best practice that involves asking patients questions to ‘close the communication loop’. Older adults were told how to take medications by a CA who used (or did not use) teachback, and then were interviewed. Older adults were open to interacting with the CA and thought it would help support self-care. They thought the CA was a more effective teacher when using teachback and that this interactive strategy helped them remember the instructions. However, teachback did not improve instruction memory.

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Goal‐setting in geriatric rehabilitation: Can the nursing profession meet patients' needs? A narrative review

Nursing Forum ◽

10.1111/nuf.12562 ◽

2021 ◽

Author(s):

Anne Marie Vaalburg ◽

Elizabeth Wattel ◽

Petra Boersma ◽

Cees Hertogh ◽

Robbert Gobbens

Keyword(s):

Goal Setting ◽

Narrative Review ◽

Nursing Profession ◽

Geriatric Rehabilitation

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PEP-CoV protocol: a PEP flute-self-care randomised controlled trial to prevent respiratory deterioration and hospitalisation in early COVID-19

BMJ Open ◽

10.1136/bmjopen-2021-050582 ◽

2021 ◽

Vol 11 (6) ◽

pp. e050582

Author(s):

Annette Mollerup ◽

Sofus Christian Larsen ◽

Anita Selmer Bennetzen ◽

Marius Henriksen ◽

Mette Kildevaeld Simonsen ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Hospital Admission ◽

Usual Care ◽

Pulmonary Disease ◽

Controlled Trial ◽

Self Care ◽

Secondary Outcome ◽

Link Type ◽

Randomised Controlled ◽

At Home

IntroductionInfection with SARS-CoV-2 may progress to severe pulmonary disease, COVID-19. Currently, patients admitted to hospital because of COVID-19 have better prognosis than during the first period of the pandemic due to improved treatment. However, the overall societal susceptibility of being infected makes it pivotal to prevent severe courses of disease to avoid high mortality rates and collapse of the healthcare systems. Positive expiratory pressure (PEP) self-care is used in chronic pulmonary disease and has been shown to prevent pneumonia in a high-risk cohort of patients with leukaemia. PEP flute self-care to prevent respiratory deterioration and hospitalisation in early COVID-19: a randomised trial (The PEP-CoV trial) examines the effectiveness on respiratory symptoms and need of hospital admission by regular PEP flute use among non-hospitalised individuals with confirmed SARS-CoV-2 infection and COVID-19 symptoms.Methods and analysisIn this randomised controlled trial, we hypothesise that daily PEP flute usage as add-on to usual care is superior to usual care as regards symptom severity measured by the COPD Assessment Test (CAT) at 30-day follow-up (primary outcome) and hospital admission through register data (secondary outcome). We expect to recruit 400 individuals for the trial. Participants in the intervention group receive a kit of 2 PEP flutes and adequate resistances and access to instruction videos. A telephone hotline offers possible contact to a nurse. The eight-item CAT score measures cough, phlegm, chest tightness, dyspnoea, activities of daily living at home, feeling safe at home despite symptoms, sleep quality and vigour. The CAT score is measured daily in both intervention and control arms by surveys prompted through text messages.Ethics and disseminationThe study was registered prospectively at www.clinicaltrials.gov on 27 August 2020 (NCT04530435). Ethical approval was granted by the local health research ethics committee (Journal number: H-20035929) on 23 July 2020. Enrolment of participants began on 6 October 2020. Results will be published in scientific journals.Trial registration numberNCT04530435; Pre-results.

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What does effective end-of-life care at home for children look like? A qualitative interview study exploring the perspectives of bereaved parents

Palliative Medicine ◽

10.1177/02692163211023300 ◽

2021 ◽

pp. 026921632110233

Author(s):

Cari Malcolm ◽

Katherine Knighting

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Care Service ◽

Life Care ◽

Care Providers ◽

Specialist Care ◽

Bereaved Parents ◽

Home Based ◽

Qualitative Interview Study ◽

At Home

Background: End-of-life care for children with life-shortening conditions is provided in a range of settings including hospital, hospice and home. What home-based, end-of-life care should entail or what best practice might look like is not widely reported, particularly from the perspective of parents who experienced the death of a child at home. Aim: To explore the value and assess the effectiveness of an innovative model of care providing home-based, end-of-life care as perceived by families who accessed the service. Design: A qualitative descriptive study design was employed with in-depth semi-structured interviews conducted with bereaved parents. Setting/participants: Thirteen bereaved parents of 10 children supported by the home-based end-of-life care service. Results: Parents reported effective aspects of end-of-life care provided at home to include: (1) ability to facilitate changes in preferred place of death; (2) trusted relationships with care providers who really know the child and family; (3) provision of child and family-centred care; (4) specialist care and support provided by the service as and when needed; and (5) quality and compassionate death and bereavement care. Parents proposed recommendations for future home-based end-of-life care including shared learning, improving access to home-based care for other families and dispelling hospice myths. Conclusion: Parents with experience of caring for a dying child at home offer valuable input to future the policy and practice surrounding effective home-based, end-of-life care for children. New models of care or service developments should consider the key components and attributes for effective home-based end-of-life identified by bereaved parents in this study.

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Patient-proxy agreement on change in acute stroke patient-reported outcome measures: a prospective study

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00329-7 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Brittany R. Lapin ◽

Nicolas R. Thompson ◽

Andrew Schuster ◽

Irene L. Katzan

Keyword(s):

Physical Function ◽

Inpatient Rehabilitation ◽

Patient Reported Outcome Measures ◽

Meaningful Change ◽

Meaningful Improvement ◽

T Score ◽

Patient Reported ◽

Exact Agreement ◽

Over Time

Abstract Objectives Research has indicated proxies overestimate symptoms on patients’ behalves, however it is unclear whether patients and proxies agree on meaningful change across domains over time. The objective of this study is to assess patient-proxy agreement over time, as well as agreement on identification of meaningful change, across 10 health domains in patients who underwent acute rehabilitation following stroke. Methods Stroke patients were recruited from an ambulatory clinic or inpatient rehabilitation unit, and were included in the study if they were undergoing rehabilitation. At baseline and again after 30 days, patients and their proxies completed PROMIS Global Health and eight domain-specific PROMIS short forms. Reliability of patient-proxy assessments at baseline, follow-up, and the change in T-score was evaluated for each domain using intra-class correlation coefficients (ICC(2,1)). Agreement on meaningful improvement or worsening, defined as 5+ T-score points, was compared using percent exact agreement. Results Forty-one patient-proxy dyads were included in the study. Proxies generally reported worse symptoms and functioning compared to patients at both baseline and follow-up, and reported less change than patients. ICCs for baseline and change were primarily poor to moderate (range: 0.06 (for depression change) to 0.67 (for physical function baseline)), and were better at follow-up (range: 0.42 (for anxiety) to 0.84 (for physical function)). Percent exact agreement between indicating meaningful improvement versus no improvement ranged from 58.5–75.6%. Only a small proportion indicated meaningful worsening. Conclusions Patient-proxy agreement across 10 domains of health was better following completion of rehabilitation compared to baseline or change. Overall change was minimal but the majority of patient-proxy dyads agreed on meaningful change. Our study provides important insight for clinicians and researchers when interpreting change scores over time for questionnaires completed by both patients and proxies.

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A behaviour change intervention to reduce home exposure to second hand smoke during pregnancy in India and Bangladesh: a theory and evidence-based approach to development

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00811-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Veena A. Satyanarayana ◽

Cath Jackson ◽

Kamran Siddiqi ◽

Prabha S. Chandra ◽

Rumana Huque ◽

...

Keyword(s):

Pregnant Women ◽

Behaviour Change ◽

Delphi Survey ◽

Behaviour Change Techniques ◽

Evidence Based ◽

Behaviour Change Intervention ◽

Behaviour Change Interventions ◽

Modified Delphi ◽

Qualitative Interview Study ◽

At Home

Abstract Background Home exposure to secondhand smoke (SHS) is highly prevalent amongst pregnant women in low- and middle-income countries like India and Bangladesh. The literature on the efficacy of behaviour change interventions to reduce home exposure to SHS in pregnancy is scarce. Methods We employed a theory and evidence-based approach to develop an intervention using pregnant women as agents of change for their husband’s smoking behaviours at home. A systematic review of SHS behaviour change interventions led us to focus on developing a multicomponent intervention and informed selection of behaviour change techniques (BCTs) for review in a modified Delphi survey. The modified Delphi survey provided expert consensus on the most effective BCTs in reducing home exposure to SHS. Finally, a qualitative interview study provided context and detailed understanding of knowledge, attitudes and practices around SHS. This insight informed the content and delivery of the proposed intervention components. Results The final intervention consisted of four components: a report on saliva cotinine levels of the pregnant woman, a picture booklet containing information about SHS and its impact on health as well strategies to negotiate a smoke-free home, a letter from the future baby to their father encouraging him to provide a smoke-free home, and automated voice reminder and motivational messages delivered to husbands on their mobile phone. Intervention delivery was in a single face-to-face session with a research assistant who explained the cotinine report, discussed key strategies for ensuring a smoke-free environment at home and practised with pregnant women how they would share the booklet and letter with their husband and supportive family members. Conclusion A theory and evidence-based approach informed the development of a multicomponent behaviour change intervention, described here. The acceptability and feasibility of the intervention which was subsequently tested in a pilot RCT in India and Bangladesh will be published later.

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