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