Laura Kivelitz1, Jonas Schäfer2, Manuela Kanat2, Jil Mohr1, Manuela Glattacker2, Sebastian Voigt-Radloff3,4, Jörg Dirmaier1. 1. Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. Section of Health Care Research and Rehabilitation Research, Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany. 3. Center for Geriatric Medicine and Gerontology Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany. 4. Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Abstract
BACKGROUND AND OBJECTIVES: Older adults suffering from multimorbidity represent a priority target group for patient-centeredness (PC). We aimed to investigate the transferability of an existing integrated model of PC comprising 15 dimensions on the care of older adults with multimorbidity from an expert perspective. RESEARCH DESIGN AND METHODS: 242 experts were invited to participate in a two-round online Delphi study. In the first round they were asked to 1) individually rate relevance and clarity of the dimensions, 2) add missing dimensions, and 3) prioritize the dimensions. In round two, experts received results of round one and were asked to re-rate their ratings. RESULTS: 48 experts participated in round one, 39 in round two. Ten dimensions were rated as sufficiently relevant and clear, including one new dimension ('prognosis and life expectancy, burden of treatment'). Four dimensions were rated as relevant but insufficiently clear. One dimension failed to reach our validation threshold on both criteria. The five dimensions rated as most important were: 'patient as a unique person', 'clinician-patient communication', 'patient involvement in care', 'physical, cognitive and emotional support', 'involvement of family and friends'. DISCUSSION AND IMPLICATIONS: The experts' ratings were higher regarding relevance than regarding clarity, which emphasizes the still existing conceptual uncertainty of PC. Our results give further directions regarding the operationalization of PC in older adults with multimorbidity, which is essential for its implementation in routine care. Further refined using focus groups with geriatric patients, our adapted model serves as a basis for a systematic review of assessment instruments.
BACKGROUND AND OBJECTIVES: Older adults suffering from multimorbidity represent a priority target group for patient-centeredness (PC). We aimed to investigate the transferability of an existing integrated model of PC comprising 15 dimensions on the care of older adults with multimorbidity from an expert perspective. RESEARCH DESIGN AND METHODS: 242 experts were invited to participate in a two-round online Delphi study. In the first round they were asked to 1) individually rate relevance and clarity of the dimensions, 2) add missing dimensions, and 3) prioritize the dimensions. In round two, experts received results of round one and were asked to re-rate their ratings. RESULTS: 48 experts participated in round one, 39 in round two. Ten dimensions were rated as sufficiently relevant and clear, including one new dimension ('prognosis and life expectancy, burden of treatment'). Four dimensions were rated as relevant but insufficiently clear. One dimension failed to reach our validation threshold on both criteria. The five dimensions rated as most important were: 'patient as a unique person', 'clinician-patient communication', 'patient involvement in care', 'physical, cognitive and emotional support', 'involvement of family and friends'. DISCUSSION AND IMPLICATIONS: The experts' ratings were higher regarding relevance than regarding clarity, which emphasizes the still existing conceptual uncertainty of PC. Our results give further directions regarding the operationalization of PC in older adults with multimorbidity, which is essential for its implementation in routine care. Further refined using focus groups with geriatric patients, our adapted model serves as a basis for a systematic review of assessment instruments.
Authors: Mimaika Luluina Ginting; Chek Hooi Wong; Zoe Zon Be Lim; Robin Wai Munn Choo; Sheena Camilla Hirose Carlsen; Grace Sum; Hubertus Johannes Maria Vrijhoef Journal: Int J Environ Res Public Health Date: 2022-04-14 Impact factor: 4.614
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