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首页> 美国卫生研究院文献>Innovation in Aging >Shared Decision Making Between Older Adult Home Health Patients and Their Caregivers: A Dyadic Coping Perspective
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Shared Decision Making Between Older Adult Home Health Patients and Their Caregivers: A Dyadic Coping Perspective

机译：年龄较大的成人家庭健康患者及其护理人员之间的共同决策：一种二次应对视角

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Older adult Home health (HH) patients comprise a medically frail population with increased inpatient and emergency department utilization. Despite the need for advance care planning among this population, rates are suboptimal. Patients rely increasingly on caregivers to advocate and coordinate their care particularly at the end of life; however surrogate decision makers are often underprepared for their roles in end-of-life decision making. This study examined shared decision making processes among older adult HH patients and caregivers during a shared decision making intervention guided by the Developmental-Contextual Model of dyadic coping (DCM). Purposive recruitment of N=18 HH patient-caregiver dyads was conducted. Patients were 55 years and above and participated with a family or non-family caregiver they nominated to the study. A 10-41 minute long video-recorded advance care planning intervention was conducted in patients’ homes and analyzed for non-verbal and verbal interactions using Noldus Observer XT 14.0. Theoretically-derived codes were applied deductively in a content analysis to examine dyadic processes associated with interactions suggesting agreement (convergent interactions) and disagreement (divergent interactions). Convergent interactions demonstrated greater alignment in illness representations and shared appraisals, and processes involving support, negotiation, and confirmation of preferences were noted. Convergent interactions also facilitated joint planning for future decisions. Disagreement on illness representations and/or shared appraisals, and overriding another’s preference was observed with divergent interactions. This study builds the groundwork for intervention refinement to promote constructive decision making and address non-constructive decision making among patient and caregivers for advance care planning.
机译：年龄较大的成人家庭健康（HH）患者包括一个医学体弱的人口，具有增加的住院患者和急诊部门利用率。尽管该人群中需要经过预付款规划，但率是次优。患者越来越依赖护理人员来倡导和协调他们的照料，特别是在生命结束;然而，代理决策者通常对其在生命结束决策中的角色造成妥善伪造。本研究在共同决策期间审查了老年成人HH患者和护理人员之间的共同决策过程，以在二级应对（DCM）的发展 - 上下文模型为指导的共同决策中。对N = 18 HH的有目的招募的患者 - 照顾者Dyads进行了。患者是55岁及以上，并参加了他们被提名参加该研究的家庭或非家庭照顾者。在患者的家庭中进行了10-41分钟的长视频录制的预先保养计划干预，并使用NOLDUS观察者XT 14.0分析非口头和口头相互作用。在含量分析中减免理论衍生的代码，以检查与互动相关的二元过程，表明协议（收敛相互作用）和分歧（发散相互作用）。收敛互动表明，在疾病陈述中表现出更大的对准，并注意到涉及支持，谈判和偏好确认的流程。收敛互动还促进了未来决策的联合规划。对疾病呈现和/或共享评估的分歧，并据称具有不同的互动。本研究建立了干预细化的基础，以促进建设性决策，并解决患者和护理人员的非建设性决策，以进行预付款规划。

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