Emergency Department Communication in Persons Living With Dementia and Care Partners: A Scoping Review

Carpenter, Christopher R.; Bellolio, Fernanda; Doering, Michelle; Hansen, Johan; Jobe, Deborah; Suyama, Joe; Aggarwal, Neelum; Allore, Heather; Aloysi, Amy; Belleville, Michael; Bellolio, M.F.; Betz, Marian E.; Biese, Kevin; Brandt, Cynthia; Bruursema, Stacey; Carnahan, Ryan M.; Carr, David B.; Chin‐Hansen, Jennie; Daven, Morgan; Degesys, Nida; Dresden, M. Scott; Dussetschleger, Jeffrey; Ellenbogen, Michael; Foster, Beverley; Gettel, Cameron J.; Gifford, Angela; Gilmore‐Bykovskyi, Andrea; Goldberg, Elizabeth M.; Han, Jin H.; Hardy, J; Hastings, Susan; Hirshon, Jon Mark; Hoang, Ly; Hogan, Teresita M.; Hung, William; Hwang, Ula; Isaacs, Eric; Jaspal, Naveena; Jobe, Deb; Johnson, Jerry; Kelly, Kathleen; Kennedy, Maura; Kind, Amy J H; Leggett, Jesseca; Malone, Michael L.; Moccia, M.; Moreno, Monica; Morrow‐Howell, Nancy; Nowroozpoor, Armin; Ohuabunwa, Ugochi; Oiyemhonlan, Brenda; Perry, William; Prusaczyk, Beth; Resendez, Jason; Rising, Kristin L.; Sano, Mary; Savage, Bob; Shah, Manish N.; Suyama, Joseph; Swartzberg, Jeremy; Taylor, Zachary; Tolia, Vaishal; Vann, Allan S.; Webb, Thompson; Weıntraub, Sandra

doi:10.1016/j.jamda.2022.02.024

Cited by 22 publications

(22 citation statements)

References 65 publications

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“…Nevertheless, PLwD are often excluded from research on communication and shared-decision-making in emergency departments and evidence-based strategies to improve ED communication for PLwD do not yet exist. [8] To develop such strategies which are appropriate and feasible, more qualitative research on healthcare workers experience of assessing patients with communication barriers is needed. One of few previous studies that have been conducted on doctors´experience of assessing patients with communication barriers found www.md-journal.com that caregiver presence can have an important role.…”

Section: Discussionmentioning

confidence: 99%

“…[6] Studies on older adults' perspectives of ED visits have identified poor communication as a problematic aspect of emergency care. [7][8][9] Further, that research exploring ED communication with PLwD is sparse. [8] A scoping review of communication between healthcare workers in EDs and patients living with dementia (PLwD) found that the dialogue was characterized by rushed communication, inconsistent information, and limited engagement in decision-making.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9] Further, that research exploring ED communication with PLwD is sparse. [8] A scoping review of communication between healthcare workers in EDs and patients living with dementia (PLwD) found that the dialogue was characterized by rushed communication, inconsistent information, and limited engagement in decision-making. This constitutes a common issue as PLwD visit the ED more frequently than patients without dementia.…”

Section: Introductionmentioning

confidence: 99%

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“You treat what you have to treat, and you don’t care as much if they understand or if they feel good about it”: Communication barriers and perceptions of moral distress among doctors in emergency departments

Brune,

Liljas

2023

Medicine

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Doctors facing communication barriers when assessing patients in emergency departments (ED) is a frequent phenomenon, as the global prevalence of dementia and migration have increased. This study aims to explore how communication barriers influence moral distress as perceived by medical doctors working at emergency departments. Twelve doctors at 2 different EDs in Stockholm, Sweden, participated. Answers on communication barriers were collected from an interview guide on moral distress. Informants’ responses were analyzed using qualitative thematic analysis. The results suggest that doctors experience moral distress when assessing patients with communication barriers due to an inability to mediate calm and safety and understand their patients, and due an increased need of resources and difficulties in obtaining consent before conducting examinations or interventions. In conclusion, communication barriers can be a cause of moral distress, which should be considered when developing tools and methods to mitigate and manage moral distress.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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“You treat what you have to treat, and you don’t care as much if they understand or if they feel good about it”: Communication barriers and perceptions of moral distress among doctors in emergency departments

Brune,

Liljas

2023

Medicine

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“…ED discharge care transitions have been prioritized within the 2014 Geriatric ED Guidelines 1 and the 2018 launch of the American College of Emergency Physicians geriatric ED accreditation process. 14 Recent ED-centric initiatives, as part of the Geriatric Emergency care Applied Research 2.0 Network -Advancing Dementia Care, [15][16][17][18] identified the need for the development of patient-and care partner-reported outcome measures that capture what matters most to stakeholders during ED care transitions. 6,9 As a first step toward developing a novel care partner-reported outcome measure, we sought to assess the barriers experienced by care partners of PLWCI during ED discharge care transitions.…”

Section: Introductionmentioning

confidence: 99%

Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment

Gettel

Serina

Uzamere

et al. 2022

A&D Transl Res & Clin Interv

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INTRODUCTION After emergency department (ED) discharge, persons living with cognitive impairment (PLWCI) and their care partners are particularly at risk for adverse outcomes. We sought to identify the barriers experienced by care partners of PLWCI during ED discharge care transitions. METHODS We conducted a qualitative study of 25 care partners of PLWCI discharged from four EDs. We used the validated 4AT and care partner‐completed AD8 screening tools, respectively, to exclude care partners of older adults with concern for delirium and include care partners of older adults with cognitive impairment. We conducted recorded, semi‐structured interviews using a standardized guide, and two team members coded and analyzed all professional transcriptions to identify emerging themes and representative quotations. RESULTS Care partners’ mean age was 56.7 years, 80% were female, and 24% identified as African American. We identified four major barriers regarding ED discharge care transitions among care partners of PLWCI: (1) unique care considerations while in the ED setting impact the perceived success of the care transition, (2) poor communication and lack of care partner engagement was a commonplace during the ED discharge process, (3) care partners experienced challenges and additional responsibilities when aiding during acute illness and recovery phases, and (4) navigating the health care system after an ED encounter was perceived as difficult by care partners. DISCUSSION Our findings demonstrate critical barriers faced during ED discharge care transitions among care partners of PLWCI. Findings from this work may inform the development of novel care partner‐reported outcome measures as well as ED discharge care transition interventions targeting care partners.

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“…Of all aspects of geriatric emergency department care, perhaps the most need is for system change related to care of persons with Alzheimer's disease and related dementias (ADRD), and the research to guide that change. 28,29 Fortunately, with support from the US National Institute on Aging, a recent series of studies has focused on this issue, resulting in separate reviews on detecting cognitive impairment and dementia in emergency department settings, 30 communication with persons with ADRD and their families, 31 optimal emergency department services for persons with ADRD, 32 and management of care transitions in persons with ADRD. 33 As in virtually all aspects of medicine, progress in improving the care of older persons is incremental and painfully slow.…”

mentioning

confidence: 99%

The Geriatric-Focused Emergency Department: Opportunities and Challenges

Sloane

2022

Journal of the American Medical Directors Association

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Emergency Department Communication in Persons Living With Dementia and Care Partners: A Scoping Review

Cited by 22 publications

References 65 publications

“You treat what you have to treat, and you don’t care as much if they understand or if they feel good about it”: Communication barriers and perceptions of moral distress among doctors in emergency departments

“You treat what you have to treat, and you don’t care as much if they understand or if they feel good about it”: Communication barriers and perceptions of moral distress among doctors in emergency departments

Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment

The Geriatric-Focused Emergency Department: Opportunities and Challenges

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