Abstract
AbstractIn Japanese medical practice, older stroke survivors are bombarded with information regarding their discharge locations, increasing their decision-making difficulties. This study used a randomized controlled trial to evaluate the influence of using decision aids (DAs) matching the values of older stroke patients and their families on the internal conflict and participation in discharge destination decisions.Participants were randomly allocated to intervention and control groups. The intervention lasted for two months, from admission to discharge, and a survey was conducted on both occasions. DAs were provided to the intervention group, and brochures to the control group. The decisional conflict scale (DCS) and the control preference scale (CPS) were the primary and secondary endpoints, respectively. An unpaired t-test and z-test analyzed inter-group differences in DCS, and CPS, respectively. This trial was registered with the University Hospital Medical Information Network (UMIN Registration No.: UMIN00032623), certified as a test registration institution by the World Health Organization.Ninety-nine participants completed a full analysis set, which revealed that the intervention group had significantly more participants who had already decided on their discharge destination while they were admitted to the hospital. These were “the same place as before admission” in a significant number of cases. No significant inter-group differences were found in the DCS and CPS scores. DAs were effective at reducing uncertainty and controlling the decline in participation rates, especially in participants living alone who were unable to decide their discharge destination, and at clarifying the values of those aged 75 and older. The DA made it possible to increase available choices and explain the disadvantages regarding various locations of discharge destinations, allowing fewer internal conflicts in the decision-making process. Going forward, there is a need to further our understanding of methods of offering DA, the ideal duration of these interventions, and the identification of beneficiaries.
Publisher
Cold Spring Harbor Laboratory
Reference48 articles.
1. Ministry of Health, Labour and Welfare. White paper on aging society. 2021 ed. (entire edition). Available from: https://www8.cao.go.jp/kourei/whitepaper/w-2021/zenbun/pdf/1s2s_02.pdf
2. The psychological process in the recovery phase of latter-stage elderly who became hemiplegic because of a cerebrovascular disease;The Bull Sci Nurs Res Ashikaga Univ,2019
3. Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults
4. Care to encourage participation of the older adult in need of long-term care in the post-discharge decision-making process: An analysis of responses shown to families and medical staff, Japanese;J Clin Nurs,2006
5. The current status and challenges of a client’s participation and decisions in multidisciplinary and inter-institution cooperation at the time of elderly’s hospital discharge;The Journal of the International University of Health and Welfare,2016