Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis.

Disalvo, D; Luckett, T; Bennett, A; Davidson, PM; Agar, M

Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis.

Disalvo, D Luckett, T

Bennett, A Davidson, PM Agar, M

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Publisher:: SPRINGER HEIDELBERG
Publication Type:: Journal Article
Citation:: European journal of clinical pharmacology, 2020, 76, (4), pp. 567-578
Issue Date:: 2020-04

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Field	Value	Language
dc.contributor.author	Disalvo, D
dc.contributor.author	Luckett, T https://orcid.org/0000-0001-6121-5409
dc.contributor.author	Bennett, A
dc.contributor.author	Davidson, PM
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119
dc.date.accessioned	2020-08-24T06:17:20Z
dc.date.available	2019-12-22
dc.date.available	2020-08-24T06:17:20Z
dc.date.issued	2020-04
dc.identifier.citation	European journal of clinical pharmacology, 2020, 76, (4), pp. 567-578
dc.identifier.issn	0031-6970
dc.identifier.issn	1432-1041
dc.identifier.uri	http://hdl.handle.net/10453/142331
dc.description.abstract	PURPOSE:This study aimed to explore medication-related decision-making by health professionals from different disciplines and specialties caring for people with advanced dementia living in long-term care facilities, focusing on dilemmas associated with starting, continuing or deprescribing medications commonly regarded as potentially inappropriate. METHODS:Four focus groups were undertaken, each on a different medication type (antibiotics, lipid-lowering agents, opioids and acetylcholinesterase inhibitors). Transcripts underwent qualitative analysis using line by line inductive coding and then a person-centred framework to highlight themes across medication types. RESULTS:Sixteen participants participated in focus groups. Regardless of medication type or dilemma, results suggested decision-making for residents with advanced dementia should begin with discussing goals of care and engaging with families, and be viewed as an iterative process involving regular monitoring and adjustment. Decision-making was seen as requiring a dialectical approach involving multiple perspectives, with an emphasis on establishing communication between health professionals, family and the person with dementia to better understand goals/preferences for care. CONCLUSION:Inter-professional collaboration enables sharing of clinical experience/expertise, differing disciplinary perspectives and knowledge about the resident. Continuing a medication should be considered an active decision that carries as much responsibility as starting or deprescribing.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SPRINGER HEIDELBERG
dc.relation.ispartof	European journal of clinical pharmacology
dc.relation.isbasedon	10.1007/s00228-019-02820-z
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	This is a post-peer-review, pre-copyedit version of an article published in [European journal of clinical pharmacology, 2020, 76, (4), pp. 567-578]. The final authenticated version is available online at: https://link.springer.com/article/10.1007/s00228-019-02820-z]”
dc.subject	1115 Pharmacology and Pharmaceutical Sciences
dc.subject.classification	Pharmacology & Pharmacy
dc.title	Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis.
dc.type	Journal Article
utslib.citation.volume	76
utslib.location.activity	Germany
utslib.for	1115 Pharmacology and Pharmaceutical Sciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2020-08-24T06:17:15Z
pubs.issue	4
pubs.publication-status	Published
pubs.volume	76
utslib.citation.issue	4

Abstract:

PURPOSE:This study aimed to explore medication-related decision-making by health professionals from different disciplines and specialties caring for people with advanced dementia living in long-term care facilities, focusing on dilemmas associated with starting, continuing or deprescribing medications commonly regarded as potentially inappropriate. METHODS:Four focus groups were undertaken, each on a different medication type (antibiotics, lipid-lowering agents, opioids and acetylcholinesterase inhibitors). Transcripts underwent qualitative analysis using line by line inductive coding and then a person-centred framework to highlight themes across medication types. RESULTS:Sixteen participants participated in focus groups. Regardless of medication type or dilemma, results suggested decision-making for residents with advanced dementia should begin with discussing goals of care and engaging with families, and be viewed as an iterative process involving regular monitoring and adjustment. Decision-making was seen as requiring a dialectical approach involving multiple perspectives, with an emphasis on establishing communication between health professionals, family and the person with dementia to better understand goals/preferences for care. CONCLUSION:Inter-professional collaboration enables sharing of clinical experience/expertise, differing disciplinary perspectives and knowledge about the resident. Continuing a medication should be considered an active decision that carries as much responsibility as starting or deprescribing.

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http://hdl.handle.net/10453/142331