How hospitalized older adults share concerns during daily rounds

Abstract

ObjectiveTo explore how hospitalized older adults’ concerns are solicited and shared during daily rounds. MethodsWe audio recorded 40 physician-patient conversations during daily rounds in a Veterans Affairs Hospital. We developed codes from the conversation analysis (a qualitative method) for the event sequence analysis (a quantitative method) to calculate the conditional probabilities of physicians soliciting for general concerns leading to patients sharing concerns. We used a mixed-effects Poisson regression to calculate the relationship between number of concerns shared and patient education. ResultsMost of the 141 concerns were shared during the assessment questions and discussion of the plan of care, such as concerns about the patient’s caregiving responsibilities. The conditional probability was higher when physicians solicited for concerns after the assessment questions (0.56) than during the opening (0.25) or the closing (0.19) of the conversation. The design of the solicitation influenced the probability of patients sharing concerns. The number of concerns shared did not differ by level of education. ConclusionPhysicians can provide opportunities for patients to share concerns. Practice implicationsSoliciting for concerns after the assessment questions, asking “what” concerns a patient may have, and asking about caregiving responsibilities may be useful for patients to share their concerns.