eprintid: 10163833 rev_number: 13 eprint_status: archive userid: 699 dir: disk0/10/16/38/33 datestamp: 2023-01-27 09:30:12 lastmod: 2023-06-13 11:06:26 status_changed: 2023-06-13 11:06:26 type: article metadata_visibility: show sword_depositor: 699 creators_name: Anantapong, Kanthee creators_name: Sampson, Elizabeth creators_name: Davies, Nathan title: A shared decision-making model about care for people with severe dementia: a qualitative study based on nutrition and hydration decisions in acute hospitals ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D79 divisions: D12 divisions: G20 divisions: FH6 keywords: Alzheimer's disease, caregiver, decision, hospital care ,person-centred care, qualitative research note: © 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. abstract: Objectives: To understand the decision-making processes regarding eating and drinking for hospital patients with severe dementia and use this data to modify a decision-making model about care for people with severe dementia. Methods: From January to May 2021, qualitative semi-structured interviews were conducted with 29 family carers and hospital staff in England who cared for people with severe dementia during hospital admissions. Interviews were transcribed verbatim and analysed using codebook thematic analysis. Results: We demonstrated a modified decision-making model consisting of six stages of the decision-making process: (i) identify a decision to be made; (ii) exchange information and recognise emotions; (iii) clarify values and preferences of all involved; (iv) consider feasibility of each choice; (v) share preferred choice and make a final decision; and (vi) deliver the decision, monitor outcomes and renegotiation. From this study, decision-making needed to be shared among all people involved and address holistic needs and personal values of people with dementia and family carers. However, hospital staff often made assumptions about the persons' ability to eat and drink without adequate consultation with family carers. The process was impacted by ward culture, professional practice, and legal framework, which might overlook cultural and personal beliefs of the persons and families. Treatment escalation plans could help inform stepwise treatments, create realistic expectations, and guide future decisions. Conclusions: Our decision-making model provides clear stages of decision-making processes and can be used to guide clinical practice and policy around care decisions for eating and drinking, which is often poorly supported. date: 2023-02 date_type: published publisher: John Wiley and Sons official_url: https://doi.org/10.1002/gps.5884 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2002172 doi: 10.1002/gps.5884 lyricists_name: Davies, Nathan lyricists_name: Sampson, Elizabeth lyricists_id: NMDAV86 lyricists_id: ELSAM39 actors_name: Davies, Nathan actors_id: NMDAV86 actors_role: owner funding_acknowledgements: [University College London] full_text_status: public publication: International Journal of Geriatric Psychiatry volume: 38 number: 2 article_number: e5884 citation: Anantapong, Kanthee; Sampson, Elizabeth; Davies, Nathan; (2023) A shared decision-making model about care for people with severe dementia: a qualitative study based on nutrition and hydration decisions in acute hospitals. International Journal of Geriatric Psychiatry , 38 (2) , Article e5884. 10.1002/gps.5884 <https://doi.org/10.1002/gps.5884>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10163833/1/Davies_A%20shared%20decision%E2%80%90making%20model%20about%20care%20for%20people%20with%20severe%20dementia%20%20A.pdf