Improving shared decision-making for osteoporosis pharmacologic therapy in nursing homes: a qualitative analysis.
Improving shared decision-making for osteoporosis pharmacologic therapy in nursing homes: a qualitative analysis.
复制标题
DOI：
10.1007/s11657-021-01050-0
复制
发表时间：
2022-01-03
影响因子：
3
通讯作者：
Berry, Sarah
中科院分区：
文献类型：
--
作者：
Colon-Emeric, Cathleen S.;Hecker, Emily J.;McConnell, Eleanor;Herndon, Laurie;Little, Milta;Xue, Tingzhong;Berry, Sarah
老年人和多发性骨质疏松症的疗养院（NH）居民的骨质疏松症药物治疗决策是复杂的，应该通过共同决策来进行。我们的目标是确定流程和工具，以改善NHS骨质疏松症药物治疗的共同决策。定性分析的数据收集在三个NHS的居民在骨折的高风险，他们的代理人，护理助理，护士，和一个执业护士（n=28）。访谈探讨了参与者的故事，态度和经验与口服骨质疏松症药物管理。框架分析被用来确定在这种情况下共同决策骨质疏松症治疗的障碍。参与者希望对骨折风险进行个体化评估，考虑不动性、高龄和共病痴呆。居民和代理人期望护理人员参与决策;护理人员希望了解药物的相对风险与益处，并给予监测说明。在共同决策过程中需要解决的两个重要的相互竞争的需求是繁重的管理要求和多种药物。参与者希望随着临床状态或护理目标的变化，随着时间的推移重新评估药物治疗的适当性。使用本分析中确定的策略和工具进行共同决策，可能会使NH和其他患有多发性骨质疏松症的老年人的骨质疏松症药物治疗从不适当的惰性转变为适当的处方或适当的不作为。决定是否使用药物治疗骨质疏松症的专业护理机构居民是复杂的，需要共同决策。居民，代理人和工作人员希望个性化的骨折风险估计，考虑到高龄，痴呆症和流动性。他们希望选择减少管理负担，监测指示，并定期重新评估风险与收益。
Decisions about pharmacologic osteoporosis treatment in Nursing Home (NH) residents with advanced age and multimorbidity are complex and should occur using shared decision making. Our objective was to identify processes and tools to improve shared decision making about pharmacologic osteoporosis treatment in NHs. Qualitative analysis of data collected in three NHs from residents at high fracture risk, their proxies, nursing assistants, nurses, and one nurse practitioner (n=28). Interviews explored participants’ stories, attitudes, and experiences with oral osteoporosis medication management. Framework Analysis was used to identify barriers to shared decision making regarding osteoporosis treatment in this setting. Participants wanted individualized fracture risk estimates that consider immobility, advanced age, and comorbid dementia. Residents and proxies expected nursing staff to be involved in decision making; nursing staff wished to be informed on the relative risks vs. benefits of medications and given monitoring instructions. Two important competing demands to address during the shared decision-making process were burdensome administration requirements and polypharmacy. Participants wanted to reassess pharmacologic treatment appropriateness over time as clinical status or goals of care change. Shared decision-making using strategies and tools identified in this analysis may move osteoporosis pharmacologic treatment in NHs and for other older adults with multimorbidity from inappropriate inertia to appropriate prescribing or appropriate inaction. Decisions on whether to use pharmacologic osteoporosis therapy in Skilled Nursing Facility residents are complex and require shared decision making. Residents, proxies and staff desire individualized fracture risk estimates that consider advanced age, dementia and mobility. They want options for reducing administration burden, monitoring instructions, and periodic reassessment of risk vs. benefit.
登录
查看更多内容
影响因子：
158.5
作者：
Lyles, Kenneth W.;Colon-Emeric, Cathleen S.;Boonen, Steven
通讯作者：
Boonen, Steven
影响因子：
4.1
作者：
Berry, Sarah D.;Zullo, Andrew R.;Kiel, Douglas P.
通讯作者：
Kiel, Douglas P.
影响因子：
2.8
作者：
Forero, Roberto;Nahidi, Shizar;Aboagye-Sarfo, Patrick
通讯作者：
Aboagye-Sarfo, Patrick
影响因子：
39
作者：
Greenspan SL;Perera S;Ferchak MA;Nace DA;Resnick NM
通讯作者：
Resnick NM
影响因子：
1.5
作者：
Elwyn G;Vermunt NPCA
通讯作者：
Vermunt NPCA