Abstract
BackgroundClinical practice guidelines for the management of complex chronic conditions in older adults encourage healthcare providers to engage patients in shared decision-making about self-management goals and actions. Yet, healthcare decision-making and communication for this population can pose significant challenges. As a result, healthcare professionals may struggle to help patients define and prioritise their values, goals, and preferences in ways that are clinically and personally meaningful, incorporating physical functioning and quality of life, when faced with numerous diagnostic and treatment alternatives. The aim of this systematic review is to locate and synthesise a body of fine-grained observational research on communication between professionals, older adults, and carers regarding self-management in audio/audio-visually recorded naturalistic interactions.Methods/designThe paper describes a systematic review of the published conversation analytic and discourse analytic research, using an aggregative thematic approach and following the PRISMA-P guidelines. This review will include studies reporting on adult patients (female or male) aged ≥ 60 years whose consultations are conducted in English in any healthcare setting and stakeholders involved in their care, e.g. general practitioners, nurses, allied health professionals, and family carers. We will search nine electronic databases and the grey literature and two independent reviewers will screen titles and abstracts to identify potential studies. Discrepancies will be resolved via consultation with the review team. The methodological quality of the final set of included studies will be appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research and a detailed description of the characteristics of the included studies using a customised template.DiscussionThis is the first systematic review to date to locate and synthesise the conversation analytic research on how healthcare professionals raise and pursue talk about self-management with older adults in routine clinical interactions. Amalgamating these findings will enable the identification of effective and potentially trainable communication practices for engaging older adults in healthcare decision-making about the self-management goals and actions that enable the greatest possible health and quality of life in older adulthood.Systematic review registrationPROSPERO CRD42019139376
Highlights
Clinical practice guidelines for the management of complex chronic conditions in older adults encourage healthcare providers to engage patients in shared decision-making about self-management goals and actions
This is the first systematic review to date to locate and synthesise the conversation analytic research on how healthcare professionals raise and pursue talk about self-management with older adults in routine clinical interactions. Amalgamating these findings will enable the identification of effective and potentially trainable communication practices for engaging older adults in healthcare decision-making about the self-management goals and actions that enable the greatest possible health and quality of life in older adulthood
Healthcare communication and decision-making for this group can pose considerable challenges. This is due to factors including (a) the need for healthcare professionals to consider the implications of multiple problems and medications within a single clinical encounter; (b) difficulties in identifying problems due to certain conditions being clinically dominant or highly symptomatic; (c) different conditions requiring separate, time-intensive treatment planning; and (d) a shortage of evidence describing interactions between and among combinations of conditions and treatments [1, 2]
Summary
A comprehensive synthesis of primary CA research on healthcare communication between health professionals, older adults, and carers regarding self-management goals and actions is lacking. This review was designed to develop a more detailed understanding of (1) how healthcare professionals in primary care communicate with older adults about goal-setting in relation to longterm condition management, (2) which communication techniques are most likely to be effective in principle, and (3) which practices cause communication difficulties or breakdown. To ensure relevance to local clinical practice and facilitate wider knowledge translation, the review findings will be shared and discussed with healthcare professionals, clinical educators, and service users at scheduled intervals through a series of consultative and collaborative meetings. The results of this review will directly inform the phase of a multi-phase knowledge translation project that aims to investigate communication problems and solutions in routine clinical encounters to improve engagement, involvement, and quality of care
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