Go to the Hospital or Stay at Home? A Qualitative Study of Expected Hospital Decision Making Among Older African Americans With Advanced Heart Failure

Hopp, Faith; Marsack, Christina; Camp, Jessica K.; Thomas, Shirley

doi:10.1080/01634372.2013.848966

Cited by 9 publications

(13 citation statements)

References 44 publications

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“…Four studies reported associations between family caregiving and patients’ healthcare utilization [29, 70, 122, 125]. A qualitative study of 10 African-American patient-caregiver dyads explored caregiver decision-making around a hypothetical scenario of going to hospital for worsening heart failure symptoms and found that caregivers often perceived themselves to have a critical role in those decisions [70].…”

Section: Resultsmentioning

confidence: 99%

“…A qualitative study of 10 African-American patient-caregiver dyads explored caregiver decision-making around a hypothetical scenario of going to hospital for worsening heart failure symptoms and found that caregivers often perceived themselves to have a critical role in those decisions [70]. Two quantitative studies reported caregiver perceptions of low social support [122], higher care hours [122], and worse depression and stress [125] predicted more frequent patient hospitalizations.…”

Section: Resultsmentioning

confidence: 99%

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Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review

et al. 2017

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Many of the 23 million individuals with heart failure (HF) worldwide receive daily, unpaid support from a family member or friend. Although HF and palliative care practice guidelines stipulate that support be provided to family caregivers, the evidence-base to guide care for this population has not been comprehensively assessed. In order to appraise the state-of-the-science of HF family caregiving and recommend areas for future research, the aims of this review were to summarize: 1) how caregivers influence patients, 2) the consequences of HF for caregivers, and 3) interventions directed at HF caregivers. We reviewed all literature to December 2015 in PubMed and CINAHL using the search terms “heart failure” AND “caregiver.” Inclusion criteria dictated that studies report original research of HF family caregiving. Articles focused on children or instrument development or aggregated HF with other illnesses were excluded. We identified 120 studies, representing 5,700 caregivers. Research on this population indicates that: 1) caregiving situations vary widely with equally wide-ranging tasks for patients to help facilitate their health behaviors, psychological health and relationships, and quality of life (QoL); 2) caregivers have numerous unmet needs that fluctuate with patients’ unpredictable medical status, are felt to be ignored by the formal healthcare system, and can lead to distress, burden, and reduced QoL; and 3) relatively few interventions have been developed and tested that effectively support HF family caregivers. We provide recommendations to move the science forward in each of these areas that moves beyond descriptive work to intervention development and clinical trials testing.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review

et al. 2017

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“…This family influence in hospitalization decisions can be confirmed by a recent study. 18 Although, it has been found that older persons who preferred to be treated at home instead of the hospital found greater comfort at home and presences of family to be important factors for this decision. 17 Involvement and collaboration with relatives should be encouraged to better support older people in need of social, psychological, or medical care.…”

Section: Discussionmentioning

confidence: 98%

“…16 Further, the majority of community dwelling older persons as well as home health care patient seem to prefer treatment at the hospital as compared to treatment at home. 17,18 Another study including older people receiving home health care due to CHF or chronic obstructive pulmonary disease, found that these older adults viewed home care as a service with limited health care resources, not capable of treating acute illnesses. 19 Knowledge about older people's own decisions of seeking hospital care can form a substantial knowledge base in understanding health utilization patterns among the elderly.…”

Section: Introductionmentioning

confidence: 98%

In Hospital We Trust: Experiences of older peoples' decision to seek hospital care

et al. 2015

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“…As far as we know, this is one of the few studies into the decision-making process of unplanned hospital admission in which is spoken with a broad group of older adults themselves during their hospitalisation. Other studies were observational [23], or after discharge and only concerned patients with home care [24], or a vignette study with heart failure patients [25], targeted care providers [26, 27], were quantitative and only focused on functional decline [28], or only focused on nursing home residents [29–31].…”

Section: Discussionmentioning

confidence: 99%

The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults: a qualitative study

Kluit

Rooij

2018

BMC Geriatr

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BackgroundThe hazards of hospitalisation, and the growing demand for goal-oriented care and shared decision making, increasingly question whether hospitalisation always aligns with the preferences and needs of older adults. Although decision models are described comprehensively in the literature, little is understood about how the decision for hospitalisation is made in real life situations, especially under acute conditions. The aim of this qualitative study was to gain insight into how the decision to hospitalise was made from the perspective of the older patient who was unplanned admitted to hospital.MethodsOpen interviews were conducted with 21 older hospitalised patients and/or their next of kin about the decision-making process leading to hospitalisation. Data were analysed according to the Constructivist Grounded Theory approach.ResultsAlthough a period of complaints preceded the decision to unplanned hospitalisation, ranging from hours to years, the decision to hospitalise was always taken acutely. In all cases, there was an acute moment in which the home as a care environment was no longer considered adequate. This conclusion was based on a combination of factors including factors related to complaints, general practitioner and home environment. Three parties were involved in this assessment: the patient, his next of kin and the general practitioner. At the same time, a very positive value was attributed towards the hospital. Depending on the assessment of the home as care environment by the various parties, there were four routes to hospitalisation: referral, shared, demanding and bypassing.ConclusionsFor all participants, the decision to hospitalisation was taken acutely, even if the problems evoking admission were not acute, but present for a longer period. Participants saw admission as inevitable, due to the negative perceptions of the care environment at home at that moment, combined with the positive expectations of hospital care. Advance care planning, nor shared decision making were rarely seen in these interviews. An ethical dilemma occurred when the next of kin consented to hospitalisation against the wishes of the patient. More attention for participation of older adults in decision making and their goals is recommended.

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Go to the Hospital or Stay at Home? A Qualitative Study of Expected Hospital Decision Making Among Older African Americans With Advanced Heart Failure

Cited by 9 publications

References 44 publications

Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review

Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review

In Hospital We Trust: Experiences of older peoples' decision to seek hospital care

The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults: a qualitative study

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