Factors associated with patient activation in an older adult population with functional difficulties

Gleason, Kelly; Tanner, Elizabeth K.; Boyd, Cynthia M.; Saczynski, Jane S.; Szanton, Sarah L.

doi:10.1016/j.pec.2016.03.011

Cited by 45 publications

(38 citation statements)

References 32 publications

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“…In order to be able to identify patients at high risk of low activation and in the context of the development of tailored interventions, an understanding of all patient- and treatment related factors associated with patient activation is needed [ 10 ]. Based on the Society to Cells Resilience framework [ 11 ], Gleason et al [ 12 ] have shown that patient activation in an older adult population with functional difficulties was related to age, family support, difficulties with activities of daily living, depressive symptoms, self-reported health, and living situation, among other factors. It is still unclear whether these factors are also predictive for patient activation in patients undergoing hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

Patient and treatment characteristics associated with patient activation in patients undergoing hemodialysis: a cross-sectional study

Bulck¹,

Claes²,

Dierickx³

et al. 2018

BMC Nephrol

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BackgroundPatient activation is associated with better outcomes and lower costs. Although the concept is widely investigated, little attention was given to patient activation and its predictors in patients undergoing hemodialysis. Hence, we aimed to investigate the level of patient activation and aimed to determine patient- and treatment-related predictors of activation in patients undergoing hemodialysis.MethodsThis cross-sectional observational study recruited patients undergoing hemodialysis in three Flemish hospitals. Participants were questioned about patient characteristics (i.e., age, sex, education, employment, children, social support, leisure-time, living condition, and care at home), treatment- and health-related characteristics (i.e., hospital, time since first dialysis, transplantation, self-reported health (EQ-VAS) and depressive symptoms (PHQ-2)), and patient activation (PAM-13). Univariate and multiple linear regression analyses with dummy variables were conducted to investigate the associations between the independent variables and patient activation.ResultsThe average patient activation-score was 51. Of 192 patients, 44% patients did not believe they had an important role regarding their health. Multiple linear regression showed that older patients, who reported being in bad health, treated in a particular hospital, without leisure-time activities, and living in a residential care home, had lower patient activation. These variables explained 31% of the variance in patient activation. Based on literature, we found that activation of patients on hemodialysis is low, compared to that of other chronic patient groups.ConclusionIt could be useful to implement patient activation monitoring, since the level of activation is low in patients undergoing hemodialysis. Older patients, who reported being in bad health, treated in a particular hospital, without leisure-time activities, living in a residential care home, are at higher risk for lower activation.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-0917-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Patient and treatment characteristics associated with patient activation in patients undergoing hemodialysis: a cross-sectional study

Bulck¹,

Claes²,

Dierickx³

et al. 2018

BMC Nephrol

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“…Only four studies used occupation as an indicator of SES, and only two studies used a composite measure of deprivation . One study measured housing situation and receipt of benefits, one used a composite measure of social class, and one looked at financial strain and finances at the end of the month . It is also important to note that many studies examined more than one type of patient participation behaviour or used more than one measure of SES.…”

Section: Resultsmentioning

confidence: 99%

“…24,25 One study measured housing situation and receipt of benefits, 26 one used a composite measure of social class, 27 and one looked at financial strain and finances at the end of the month. 28 It is also important to note that many studies examined more than one type of patient participation behaviour or used more than one measure of SES. Most studies (33) used more than one measure of SES, whereas only 18 studies examined more than one type of patient participation behaviour (Table 2).…”

Section: Re Sultsmentioning

confidence: 99%

Socio‐economic differences in patient participation behaviours in doctor–patient interactions—A systematic mapping review of the literature

Allen

Rogers

Harris

2019

Health Expectations

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BackgroundThe degree to which patients participate in their care can have a positive impact on health outcomes. This review aimed to map the current literature on patient participation behaviours in interactions with physicians and the extent to which differences in these behaviours can be explained by socio‐economic status (SES).Search strategyFour electronic databases were searched from 1980 onwards using key words related to socio‐economic status and patient participation behaviours.Study selectionTitles, abstracts and full texts were screened by two reviewers, with the second reviewer screening 20% of all entries.Data extractionData on year of publication, country, patient population, setting, patient participation behaviour studied, and SES measure used were extracted.Main resultsForty‐nine studies were included in the review. Most studies were conducted in the United States, and the most commonly studied patient participation behaviour was involvement in decision making. Most studies measured SES using education as an indicator, with very few studies using occupation as a measure. Many studies did not report on participants’ medical condition or study setting. Patient participation in their health‐care appointment increased with increasing SES in 24 studies, although in 27 studies no significant association was found.Discussion and conclusionsCurrent literature was found to be mainly US‐centric. Many studies did not specify participants’ medical condition or in what setting the study was undertaken. More studies are needed on less commonly studied patient participation behaviours. It would be helpful for further studies to also include a wider range of SES indicators.

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“…This is likely to be particularly important for older people with complex needs, as older age, depression (which is often linked to LTCs) and difficulties with activities of daily living are associated with decreased patient activation. 170 The evidence highlights key contextual factors such as longer consultations, clinicians' communication skills and a culture that allows people to ask questions without feeling judged. These are likely to lead to an increased ability and willingness to engage in decision-making through mechanisms such as feeling respected and understood.…”

Section: Discussionmentioning

confidence: 99%

“…Older age, depressive symptoms and difficulties with the activities of daily living are associated with decreased patient activation; 170 interventions may therefore need to be tailored to older adults' level of patient activation and address issues such as depression. 170 A review of decision aids for older people reported that they improve older adults' knowledge, increase their risk perception, decrease decisional conflict and seem to enhance participation in SDM. 121 These findings were supported by a patient-level meta-analysis that looked at the impact of characteristics such as age on the efficacy of decision aids.…”

Section: Decision Aidsmentioning

confidence: 99%

Supporting shared decision-making for older people with multiple health and social care needs: a realist synthesis

Bunn

Goodman

Russell

et al. 2018

Health Serv Deliv Res

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BackgroundHealth-care systems are increasingly moving towards more integrated approaches. Shared decision-making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; this is particularly the case for older people with complex needs.ObjectivesTo provide a context-relevant understanding of how models to facilitate SDM might work for older people with multiple health and care needs and how they might be applied to integrated care models.DesignRealist synthesis following Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standards.ParticipantsTwenty-four stakeholders took part in interviews.Data sourcesElectronic databases including MEDLINE (via PubMed), The Cochrane Library, Scopus, Google and Google Scholar (Google Inc., Mountain View, CA, USA). Lateral searches were also carried out. All types of evidence were included.Review methodsIterative stakeholder-driven, three-stage approach, involving (1) scoping of the literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, (2) systematic searches for evidence to test and develop the theories and (3) validation of programme theory/ies with stakeholders (n = 11).ResultsWe included 88 papers, of which 29 focused on older people or people with complex needs. We identified four theories (context–mechanism–outcome configurations) that together provide an account of what needs to be in place for SDM to work for older people with complex needs: understanding and assessing patient and carer values and capacity to access and use care; organising systems to support and prioritise SDM; supporting and preparing patients and family carers to engage in SDM; and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that create trust between those involved, allow service users to feel that they are respected and understood, and engender confidence to engage in SDM.LimitationsThere is a lack of evidence on interventions to promote SDM in older people with complex needs or on interprofessional approaches to SDM.ConclusionsModels of SDM for older people with complex health and care needs should be conceptualised as a series of conversations that patients, and their family carers, may have with a variety of different health and care professionals. To embed SDM in practice requires a shift from a biomedical focus to a more person-centred ethos. Service providers are likely to need support, both in terms of the way services are organised and delivered and in terms of their own continuing professional development. Older people with complex needs may need support to engage in SDM. How this support is best provided needs further exploration, although face-to-face interactions and ongoing patient–professional relationships are key.Future workThere is a need for further work to establish how organisational structures can be better aligned to meet the requirements of older people with complex needs. This includes a need to define and evaluate the contribution that different members of health and care teams can make to SDM for older people with complex health and care needs.Study registrationThis study is registered as PROSPERO CRD42016039013.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Factors associated with patient activation in an older adult population with functional difficulties

Cited by 45 publications

References 32 publications

Patient and treatment characteristics associated with patient activation in patients undergoing hemodialysis: a cross-sectional study

Patient and treatment characteristics associated with patient activation in patients undergoing hemodialysis: a cross-sectional study

Socio‐economic differences in patient participation behaviours in doctor–patient interactions—A systematic mapping review of the literature

Supporting shared decision-making for older people with multiple health and social care needs: a realist synthesis

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