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Finding a ‘new normal’ following acute illness: A qualitative study of influences on frail older people’s care preferences

BACKGROUND: The frail older population is growing, and many frail older people have episodes of acute illness. Patient preferences are increasingly considered important in the delivery of person-centred care and may change following acute illness. AIM: To explore influences on the care preferences o...

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Autores principales: Etkind, Simon Noah, Lovell, Natasha, Nicholson, Caroline Jane, Higginson, Irene J, Murtagh, Fliss EM
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376597/
https://www.ncbi.nlm.nih.gov/pubmed/30526371
http://dx.doi.org/10.1177/0269216318817706
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author Etkind, Simon Noah
Lovell, Natasha
Nicholson, Caroline Jane
Higginson, Irene J
Murtagh, Fliss EM
author_facet Etkind, Simon Noah
Lovell, Natasha
Nicholson, Caroline Jane
Higginson, Irene J
Murtagh, Fliss EM
author_sort Etkind, Simon Noah
collection PubMed
description BACKGROUND: The frail older population is growing, and many frail older people have episodes of acute illness. Patient preferences are increasingly considered important in the delivery of person-centred care and may change following acute illness. AIM: To explore influences on the care preferences of frail older people with recent acute illness. DESIGN: Qualitative in-depth individual interviews, with thematic analysis. SETTING/PARTICIPANTS: Maximum variation sample of 18 patients and 7 nominated family carers from a prospective cohort study of people aged over 65, scoring ⩾5 on the Clinical Frailty Scale, and with recent acute illness, who were not receiving specialist palliative care. Median patient age was 84 (inter-quartile range 81–87), 53% female. Median frailty score 6 (inter-quartile range 5–7). RESULTS: Key influences on preferences were illness and care context, particularly hospital care; adaptation to changing health; achieving normality and social context. Participants focused on the outcomes of their care; hence, whether care was likely to help them ‘get back to normal’, or alternatively ‘find a new normal’ influenced preferences. For some, acute illness inhibited preference formation. Participants’ social context and the people available to provide support influenced place of care preferences. We combined these findings to model influences on preferences. CONCLUSION: ‘Getting back to normal’ or ‘finding a new normal’ are key focuses for frail older people when considering their preferences. Following acute illness, clinicians should discuss preferences and care planning in terms of an achievable normal, and carefully consider the social context. Longitudinal research is needed to explore the influences on preferences over time.
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spelling pubmed-63765972019-03-16 Finding a ‘new normal’ following acute illness: A qualitative study of influences on frail older people’s care preferences Etkind, Simon Noah Lovell, Natasha Nicholson, Caroline Jane Higginson, Irene J Murtagh, Fliss EM Palliat Med Original Articles BACKGROUND: The frail older population is growing, and many frail older people have episodes of acute illness. Patient preferences are increasingly considered important in the delivery of person-centred care and may change following acute illness. AIM: To explore influences on the care preferences of frail older people with recent acute illness. DESIGN: Qualitative in-depth individual interviews, with thematic analysis. SETTING/PARTICIPANTS: Maximum variation sample of 18 patients and 7 nominated family carers from a prospective cohort study of people aged over 65, scoring ⩾5 on the Clinical Frailty Scale, and with recent acute illness, who were not receiving specialist palliative care. Median patient age was 84 (inter-quartile range 81–87), 53% female. Median frailty score 6 (inter-quartile range 5–7). RESULTS: Key influences on preferences were illness and care context, particularly hospital care; adaptation to changing health; achieving normality and social context. Participants focused on the outcomes of their care; hence, whether care was likely to help them ‘get back to normal’, or alternatively ‘find a new normal’ influenced preferences. For some, acute illness inhibited preference formation. Participants’ social context and the people available to provide support influenced place of care preferences. We combined these findings to model influences on preferences. CONCLUSION: ‘Getting back to normal’ or ‘finding a new normal’ are key focuses for frail older people when considering their preferences. Following acute illness, clinicians should discuss preferences and care planning in terms of an achievable normal, and carefully consider the social context. Longitudinal research is needed to explore the influences on preferences over time. SAGE Publications 2018-12-07 2019-03 /pmc/articles/PMC6376597/ /pubmed/30526371 http://dx.doi.org/10.1177/0269216318817706 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by/4.0/ This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Etkind, Simon Noah
Lovell, Natasha
Nicholson, Caroline Jane
Higginson, Irene J
Murtagh, Fliss EM
Finding a ‘new normal’ following acute illness: A qualitative study of influences on frail older people’s care preferences
title Finding a ‘new normal’ following acute illness: A qualitative study of influences on frail older people’s care preferences
title_full Finding a ‘new normal’ following acute illness: A qualitative study of influences on frail older people’s care preferences
title_fullStr Finding a ‘new normal’ following acute illness: A qualitative study of influences on frail older people’s care preferences
title_full_unstemmed Finding a ‘new normal’ following acute illness: A qualitative study of influences on frail older people’s care preferences
title_short Finding a ‘new normal’ following acute illness: A qualitative study of influences on frail older people’s care preferences
title_sort finding a ‘new normal’ following acute illness: a qualitative study of influences on frail older people’s care preferences
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376597/
https://www.ncbi.nlm.nih.gov/pubmed/30526371
http://dx.doi.org/10.1177/0269216318817706
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