Communicating with older adults with long-term conditions about self-management goals: A systematic review and thematic synthesis

Michael T Lawless; Phoebe Drioli-Phillips; Mandy M Archibald; Rachel C Ambagtsheer; Alison L Kitson

doi:10.1016/j.pec.2021.02.035

Communicating with older adults with long-term conditions about self-management goals: A systematic review and thematic synthesis

Patient Educ Couns. 2021 Oct;104(10):2439-2452. doi: 10.1016/j.pec.2021.02.035. Epub 2021 Feb 20.

Authors

Michael T Lawless¹, Phoebe Drioli-Phillips², Mandy M Archibald³, Rachel C Ambagtsheer⁴, Alison L Kitson⁵

Affiliations

¹ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia. Electronic address: michael.lawless@flinders.edu.au.
² School of Psychology, The University of Adelaide, Adelaide, SA, 5005, Australia. Electronic address: phoebe.drioli-phillips@adelaide.edu.au.
³ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia; College of Nursing Helen Glass Centre for Nursing, 99 Curry Place University of Manitoba, Winnipeg, Canada. Electronic address: mandy.archibald@umanitoba.ca.
⁴ National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia; Torrens University Australia, 88 Wakefield Street, Adelaide, SA, 5000, Australia. Electronic address: rambagtsheer@laureate.net.au.
⁵ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia. Electronic address: alison.kitson@flinders.edu.au.

PMID: 33658141
DOI: 10.1016/j.pec.2021.02.035

Abstract

Objective: To synthesise a body of fine-grained observational research on communication between healthcare professionals (HCPs), older adults, and carers regarding self-management goals and actions.

Methods: We conducted a systematic review, searching nine electronic databases and the grey literature. Two reviewers independently selected for inclusion following a two-stage process and studies and discrepancies were resolved through consultation with the review team.

Results: 898 records were retrieved, and eight studies were included in the review. Aggregative thematic analysis resulted in 13 categories of communication practices across three decision-making domains: (1) initiating: actions occurring prior to the commitment point; (2) proposing: putting forward a course of action; and (3) committing and closing: committing (or not) to the course of action.

Conclusions: Despite an increasing emphasis on the importance of personalised care planning and shared decision-making (SDM) to support older people's health and wellbeing, HCPs did not consistently practice this approach and, in some cases, worked in opposition to it.

Practice implications: We encourage HCPs to prepare older adults to engage actively with SDM and the goal setting process by employing patient-centred communication resources. These could assist with identifying different types of goals that are realistic and relevant to patients in daily life.

Keywords: Aged; Chronic illness and disease; Conversation analysis; Frail elderly; Health communication; Qualitative research; Self-Management; Shared decision-making; Systematic review.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Aged
Caregivers
Communication
Decision Making, Shared
Health Personnel
Humans
Self-Management*