Towards patient-centred communication in the management of older patients' medications across transitions of care: A focused ethnographic study.

Abstract

Communication about managing medications during transitions of care can be a challenging process for older patients since they often have complex medication regimens. Previous studies highlighted that links between communication breakdowns and medication incidents in older patients occur mainly at discharge or in the post-discharge period. Little attention has been paid to exploring communication strategies facilitating patient-centred medication communication at transitions of care from a discourse-analytic perspective. To explore, through a discursive lens, strategies that enable patient-centred medication communication at transitions of care. A focused ethnographic study was employed for this study. The study was reported according to the COREQ checklist. Interviews, observations and focus groups were analysed utilising Critical Discourse Analysis and the Medication Communication Model following thematic analysis. Data collection was undertaken in eight wards across two metropolitan hospitals in Australia. Patient preferences and beliefs about medications were identified as important characteristics of patient-centred communication. Strategies included empathetic talk prioritising patients' medication needs and preferences for medications; informative talk clarifying patients' concerns; and encouraging talk for enhancing shared decision-making with older patients. Challenges relating to the use of these strategies included patients' hearing, speech or cognitive impairments, language barriers and absence of interpreters or family members during care transitions. To enhance medication communication, nurses, doctors and pharmacists should incorporate older patients' preferences, previous experiences and beliefs, and consider the challenges faced by patients across transitions. Strategies encouraging patients' contribution to decision-making processes are crucial to patient-centeredness in medication communication. Nurses need to engage in informative talk more frequently when administering the medications to ensure older patients' understanding of medications prescribed or altered in hospital settings.