How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA

Selman, L.E.; Daveson, B.A.; Smith, M.; Johnston, B.; Ryan, K.; Morrison, R.S.; Pannell, C.; McQuillan, R.; de Wolf-Linder, Susanne; Pantilat, S.Z.; Klass, L.; Meier, D.; Normand, C.; Higginson, I.J.

doi:10.21256/zhaw-3926

Please use this identifier to cite or link to this item: https://doi.org/10.21256/zhaw-3926

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DC Field	Value	Language
dc.contributor.author	Selman, L.E.	-
dc.contributor.author	Daveson, B.A.	-
dc.contributor.author	Smith, M.	-
dc.contributor.author	Johnston, B.	-
dc.contributor.author	Ryan, K.	-
dc.contributor.author	Morrison, R.S.	-
dc.contributor.author	Pannell, C.	-
dc.contributor.author	McQuillan, R.	-
dc.contributor.author	de Wolf-Linder, Susanne	-
dc.contributor.author	Pantilat, S.Z.	-
dc.contributor.author	Klass, L.	-
dc.contributor.author	Meier, D.	-
dc.contributor.author	Normand, C.	-
dc.contributor.author	Higginson, I.J.	-
dc.date.accessioned	2018-08-02T14:39:29Z	-
dc.date.available	2018-08-02T14:39:29Z	-
dc.date.issued	2017	-
dc.identifier.issn	1468-2834	de_CH
dc.identifier.issn	0002-0729	de_CH
dc.identifier.uri	https://digitalcollection.zhaw.ch/handle/11475/8833	-
dc.description	Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)	de_CH
dc.description.abstract	Background: Patient empowerment, through which patients become self-determining agents with some control over their health and healthcare, is a common theme across health policies globally. Most care for older people is in the acute setting, but there is little evidence to inform the delivery of empowering hospital care. Objective: We aimed to explore challenges to and facilitators of empowerment among older people with advanced disease in hospital, and the impact of palliative care. Methods: We conducted an ethnography in six hospitals in England, Ireland and the USA. The ethnography involved: interviews with patients aged ≥65, informal caregivers, specialist palliative care (SPC) staff and other clinicians who cared for older adults with advanced disease, and fieldwork. Data were analysed using directed thematic analysis. Results: Analysis of 91 interviews and 340 h of observational data revealed substantial challenges to empowerment: poor communication and information provision, combined with routinised and fragmented inpatient care, restricted patients’ self-efficacy, self-management, choice and decision-making. Information and knowledge were often necessary for empowerment, but not sufficient: empowerment depended on patient-centredness being enacted at an organisational and staff level. SPC facilitated empowerment by prioritising patient-centred care, tailored communication and information provision, and the support of other clinicians. Conclusions: Empowering older people in the acute setting requires changes throughout the health system. Facilitators of empowerment include excellent staff-patient communication, patient-centred, relational care, an organisational focus on patient experience rather than throughput, and appropriate access to SPC. Findings have relevance for many high- and middle-income countries with a growing population of older patients with advanced disease.	de_CH
dc.language.iso	en	de_CH
dc.publisher	Oxford University Press	de_CH
dc.relation.ispartof	Age and Ageing	de_CH
dc.rights	Licence according to publishing contract	de_CH
dc.subject	Empowerment	de_CH
dc.subject	Inpatient	de_CH
dc.subject	Hhospital	de_CH
dc.subject	Aged	de_CH
dc.subject	Palliative care	de_CH
dc.subject	Older people	de_CH
dc.subject.ddc	305: Personengruppen (Alter, Herkunft, Geschlecht, Einkommen)	de_CH
dc.subject.ddc	362.11: Krankenhäuser und verwandte Einrichtungen	de_CH
dc.title	How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA	de_CH
dc.type	Beitrag in wissenschaftlicher Zeitschrift	de_CH
dcterms.type	Text	de_CH
zhaw.departement	Gesundheit	de_CH
zhaw.organisationalunit	Institut für Pflege (IPF)	de_CH
dc.identifier.doi	10.21256/zhaw-3926	-
dc.identifier.doi	10.1093/ageing/afw193	de_CH
zhaw.funding.eu	No	de_CH
zhaw.issue	2	de_CH
zhaw.originated.zhaw	Yes	de_CH
zhaw.pages.end	309	de_CH
zhaw.pages.start	300	de_CH
zhaw.publication.status	publishedVersion	de_CH
zhaw.volume	46	de_CH
zhaw.publication.review	Peer review (Publikation)	de_CH
zhaw.webfeed	Angewandte Gerontologie	de_CH
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Selman, L. E., Daveson, B. A., Smith, M., Johnston, B., Ryan, K., Morrison, R. S., Pannell, C., McQuillan, R., de Wolf-Linder, S., Pantilat, S. Z., Klass, L., Meier, D., Normand, C., & Higginson, I. J. (2017). How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA. Age and Ageing, 46(2), 300–309. https://doi.org/10.21256/zhaw-3926

Selman, L.E. et al. (2017) ‘How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA’, Age and Ageing, 46(2), pp. 300–309. Available at: https://doi.org/10.21256/zhaw-3926.

L. E. Selman et al., “How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA,” Age and Ageing, vol. 46, no. 2, pp. 300–309, 2017, doi: 10.21256/zhaw-3926.

SELMAN, L.E., B.A. DAVESON, M. SMITH, B. JOHNSTON, K. RYAN, R.S. MORRISON, C. PANNELL, R. MCQUILLAN, Susanne DE WOLF-LINDER, S.Z. PANTILAT, L. KLASS, D. MEIER, C. NORMAND und I.J. HIGGINSON, 2017. How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA. Age and Ageing. 2017. Bd. 46, Nr. 2, S. 300–309. DOI 10.21256/zhaw-3926

Selman, L.E., B.A. Daveson, M. Smith, B. Johnston, K. Ryan, R.S. Morrison, C. Pannell, et al. 2017. “How Empowering Is Hospital Care for Older People with Advanced Disease? Barriers and Facilitators from a Cross-National Ethnography in England, Ireland and the USA.” Age and Ageing 46 (2): 300–309. https://doi.org/10.21256/zhaw-3926.

Selman, L. E., et al. “How Empowering Is Hospital Care for Older People with Advanced Disease? Barriers and Facilitators from a Cross-National Ethnography in England, Ireland and the USA.” Age and Ageing, vol. 46, no. 2, 2017, pp. 300–9, https://doi.org/10.21256/zhaw-3926.