2. Materials and Methods
2.2. Study Design
2.4. Ethical Considerations
2.5. Quantitative Data
2.6. Quantitative Data Collections
2.6.2. Observing Patient Involvement Measurement (OPTION 5)
2.7. Quantitative Analysis and Statistics
2.8. Qualitative Data
2.9. Qualitative Data Collection
2.9.2. Semi-Structured Interviews
2.10. Qualitative Analysis
2.11. Integration of Data
3.2. Quantitative Results Presenting Option 5 and Items’ Scores
3.3. Integrating Quantitative and Qualitative Data
3.4. Overall Themes including Both Quantitative and Qualitative Data
- A low degree of SDM in conversations about medicine.
- A variation in the pro-active and non-active patient approach to conversations about medicine.
- No information on side effects.
- A preference for medication reduction.
3.4.1. Theme 1: A Low Degree of SDM in Conversations about Medicine in the ED
“No, I don’t think so, but it appeared we should hurry, I’m not sure, I’m not sure. [……….] No, I didn’t think we were talking about medicine, at all, but it is possible I was a little dazed when I first came in” (Pt ID #16).
Interviewer: “When you were in the Emergency Department, did anyone discuss your medication with you?” Patient: “No, they have everything in writing, so there is nothing to discuss. They simply glance at their screens to know what you get and don’t get” (Pt ID #2).
3.4.2. Theme 2: A Variation in the Pro-Active and Non-Active Patients’ Approach to Conversations about Medicine
“Yes, indeed, I believe I was engaged because they listened and heard what I had to say. I communicated my dissatisfaction and worry with the situation and my attitude toward it (the medicine). To me, it’s natural” (Pt ID #21).
“I’ve only just picked up on what was said to me. That is something I have to admit. I presume that the physicians who have dealt with me in the situations, that they are most familiar with what is the best. So, with what is required, I replied: “Yes, thank you.” But because I have no sense of medicine, I hear what the experts say to me, right?” (Pt ID #19).
“Well, it (involvement) would be wonderful for someone who does not have much control over it and is, if I may say so, gullible” (Pt ID #17).
“No, I don’t want to get involved, but the day when I am unable to care for myself, I would like to be involved in my medication” (Pt ID #5).
“I just got home, and my medicine says right here (on the medicine list) Losartan, which is the blood pressure medication I take once a day. The patient examines the medicine list attentively and states: It does not say whether it is for the blood pressure to rise or fall? I’m not sure of that” (Pt ID #11).
“Well, I care a lot, and I’ll try to follow what I get of medicine, and I can be skeptical if I get another medicine because if I was feeling fine with one, why suddenly switch to another? And yes, it does matter that I get involved in it. If not, I’ll look it up on the Internet myself if I don’t get clear information from the doctor. So, you can do that, and I will do it, or I get help from my grandson because I think they were terrible at informing people about it” (Pt ID #12).
3.4.3. Theme 3: No Information on Side Effects
“You see, I have such a fluctuating blood sugar and blood pressure, and the blood pressure is often too low, and in the last weeks I fell, so I have been extremely anxious about receiving too much medicine. It lowers my blood pressure” (Pt ID #21).
“No, that has not been discussed. They haven’t discussed it at all. But I guess they know what’s wrong with me and have looked into it” (Pt ID #5).
3.4.4. Theme 4: A Preference for Medication Reduction
“So, I think it would be nice if they inquired about your medication’s status. But then you have the thought in the back of your head that, uhh, they are so busy, they don’t have time [……].It would be wonderful if they asked if everything is OK with the medication you are receiving. Is there anything else you think should be changed? That would have been fantastic in my opinion” (Pt ID #17).
“You know what, I do not have much time left, so I don’t want to get involved. But I hope that what I get is something that will benefit me in some way. I assume that the physicians have examined everything and that I receive only what I require and nothing else” (Pt ID #2).
Interviewer: “But would you like to take less medicine?”
Patient: “Yes, in a way, because there are usually some side effects, and I experienced dizziness and they reduced the diuretics, because I became so dizzy” (Pt ID #2).
Methodological Strength and Limitations
Implication for Healthcare Professionals
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Telephone (T) or Home (H)
|Home Care or Kindship for Medicine Administration|
|Theme 1: Explore whether the patient recalls any medication-related conversations in the ED|
|1. Opening Question: Do you recall speaking with anybody (physician, nurse, or pharmacist) about your medication during your ED stay?|
|2. How did you feel about the medication conversations in the ED?|
|3. How did you experience being part of the decision-making process for your medication?|
|Theme 2: Examine the patient’s experience of being engaged in medication choices in the ED|
|4. What are your thoughts on being (or not being) involved, in the way that you did?|
|5. When it comes to your medicine, what is the most crucial thing for you to be engaged in?|
|6. How would you rather make decisions about your medicine?|
|Theme 3: Examine to see if the patient experienced SDM in conversations with the healthcare professionals about medicine (the Collaborate questionnaire inspired the following three questions)|
|7. How did you feel about the healthcare professionals’ efforts to explain your medicine to you?|
|8. How did you feel about the healthcare professionals’ efforts to understand what was most important to you in your medication?|
|9. How was the impression of the effort made to incorporate what matters most to you in your future medication?|
|Characteristics||Observations Healthcare Professionals, n = 31 (Quantitative)||Interview Patients, n = 14 (Qualitative)|
|Women, n (%)||18 (58.1)||8 (57.1)|
|Men, n (%)||13 (41.9)||6 (42.9)|
|Experiences, mean (years)||14.7||-|
|Age mean (years)||41.2 (range 26–65)||84.6 (range 75–94)|
|Number of medications, mean||-||9.4|
|For the health issue being discussed, the clinician draws attention to or confirms that alternate treatment or management options exist or that the need for a decision exists. If the patient rather than the clinician draws attention to the availability of options, the clinician responds by agreeing that the options need deliberation.||41||16.5||4.5||3||0||0.53|
|2. Establishing a partnership with the|
|The clinician reassures the patient or reaffirms that the clinician will support the patient to become informed or deliberate about the options. If the patient states that they have sought or obtained information prior to the encounter, the clinician supports such a deliberation process.||61||0||1||3||0||0.17|
|3. Describing pros and cons of options||The clinician gives information or checks understanding about the options that are considered reasonable (this can include taking no action), to support the patient in comparing alternatives. If the patient requests clarification, the clinician supports the process.||51||8||3||2||1||0.37|
|The clinician makes an effort to elicit the patient’s preferences in response to the options that have been described. If the patient declares their preference(s), the clinician is supportive.||51||5||5||2||1||0.38|
|5. Integrating patient|
preferences into the decision
|The clinician makes an effort to integrate the patient’s elicited preferences as decisions are made. If the patient indicates how best to integrate their preferences as decisions are made, the clinician makes an effort to do so.||58.5||1.5||4||1||0||0.19|
|Total OPTION 5 score: Summed for all 5 items||1.64|
|Total OPTION 5 score: Rescaled to 0–100||8.2|
OPTION 5 Score and Item Points
|Confirmation, Discordance, or Expansion from Findings|
|Sparse communication about medicine in the ED||Theme 1: A low degree of SDM in conversations about medicine in the ED|
Most patients had not experienced much communication about their medicine and were not even aware that they could have different medicine options.
|Total mean score: 8.2 (out of 100)||Confirmation|
Each analysis confirms that there is sparse SDM and communication about medicine in the ED.
|Power disparities prevent dialogues about medicine||Theme 2: A variation in the pro-active and non-active patients’ approach to conversations about medicine|
Some pro-active patients were very much involved in decisions about their medicine in contrast to the non-active patients who were divided into two sub-groups. Some patients preferred to leave decisions to the healthcare professionals. The other sub-group was afraid of revealing that they were not in control of their medicine.
|Item 2: Establishing a partnership with the patient|
(Mean points: 0.17)
Item 3: Describing pros and cons of options
(Mean points: 0.37)
We found a variation between the pro-active and non-active patients’ approach, which influenced how much information and involvement the patient received and how satisfied they were with the information and involvement.
|Talk about side effects||Theme 3: No information of side effects|
Most patients had preferences for more discussions about side effects, but this was rarely discussed or asked for. The low score on Item 4: Eliciting patient preferences also reflects that the healthcare professionals rarely investigate patients’ preferences, which also are reflected in theme 4.
|Item 4: Eliciting patient preferences|
(Mean points: 0.38)
There are discordant findings in the two analyses because the Item 4 score is low (Mean 0.38), reflecting that the healthcare professionals rarely investigate patient preferences. However, older poly-medicated patients have preferences for more discussions and information of side effects and the option of reducing medicine, as do the non-active patients, even though they do not ask for it themselves.
|Preferences for deprescribing||Theme 4: A preference for medication reduction|
Most patients preferred to take less medicine, but this option was rarely discussed (which also was reflected in the low Item 4 score) unless the pro-active patients asked for it themselves. For non-active patients, they lacked the desire to engage actively in decision making because of vulnerability and limited life horizon, so they had to put trust in their medicine and felt that there was no other choice.
|Mean||SD||Median||Lower IQR||Upper IQR|
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