Patient-centredness in acute stroke care - a qualitative study from the perspectives of patients, relatives and staff.

BACKGROUND AND PURPOSE: Although patient-centredness is considered a key component of high-quality neurological care, it is unclear to what extent it can or should be implemented during the acute phase. Using acute stroke as an example, the aim was to identify critical junctures for patient-centredness along the acute care pathway from the perspectives of patients, relatives and staff. METHODS: A qualitative multi-method study was conducted including 27 non-participant observations and 37 semi-structured interviews with patients, relatives and staff. Junctures were defined as critical when mentioned (as problematic) in two or three information sources (i.e. observations, staff interviews, or patient and relative interviews), as potentially critical when mentioned in one, and as uncritical when not mentioned. RESULTS: Post-procedure communication after thrombectomy, patients' stay at the stroke unit and decision-making around transfer, discharge and rehabilitation were identified as critical junctures for patient-centredness. Arrival at the emergency department and the (thrombectomy) treatment itself were identified as uncritical junctures, whilst history-taking and treatment preparation, the treatment decision and patients' stay at the intensive care unit were identified as potentially critical junctures. CONCLUSIONS: In acute stroke care, patients, relatives and staff prioritize fast over patient-centred decision-making in the most time-critical phases, especially before and during treatment. This is reversed after the procedure, when difficulties arise implementing a patient-centred approach in clinical practice. To improve patient-centredness where it is most needed, clear guidelines and accessible resources are recommended. Future research should investigate whether insights from acute phases of stroke care are applicable to other neurological conditions as well.

[Shared decision-making in prostate cancer patients]. / Partizipative Entscheidungsfindung bei Prostatakrebspatienten.

BACKGROUND: Shared decision-making (SDM) is becoming increasingly important in medical care. The relevance of SDM after diagnosis is especially noticeable in the care of prostate cancer patients, since affected patients can choose from different treatment strategies. OBJECTIVES: What are the experiences of patients regarding SDM in the treatment of prostate cancer? METHODS: Interviews with qualitative-exploratory study design were carried out and evaluated. The interviews were recorded with the help of audio tapes and literally transcribed and pseudonymized based on Kuckartz. The evaluation was done by theoretical coding according to Glaser and Strauss. This enabled the development of an object-based theory of interview data. RESULTS: The study shows that all interviewees experienced SDM and were able to reflect on this process. The interviewed patients had a high level of information regarding their disease status and treatment options, in which individual preferences played a key role. Some patients saw potential for optimization in the physician-patient conversation, taking personal preferences into account. CONCLUSIONS: Patients are not limited to medical information only, but have taken an active role in their treatment decision. Many of the participants consulted several physicians to obtain second opinions. Since the survey focuses on the patients' perspective, it remains unclear whether a joint exchange of information and decision-making has taken place from a medical point of view.