1. Engaging Older Adult Patients in Primary Care Settings
Kathleen Pauloff, MSc (c), Jacobi Elliott, PhD, Paul Stolee, PhD
School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
Email: kat.pauloff@uwaterloo.ca Website: www.uwaterloo.ca/ghs
Background & Purpose
An important aspect of patient-centred care is meaningful engagement in decision-making, which involves
gaining a comprehensive understanding of each patient's needs, wants, preferences and circumstances.
There is little consensus on best practices for achieving meaningful engagement in busy, resource-limited
healthcare settings.
Purpose:
This project aimed to gain insight into relevant challenges and successes by speaking with older adult
patients, family caregivers and healthcare providers about current engagement practices in primary care
settings.
For More Information please email
Kathleen at:
kat.pauloff@uwaterloo.ca or visit our
website at: www.uwaterloo.ca/ghs
General findings:
- The majority of participants shared an interest in building meaningful
relationships with their primary care providers.
- Many of them believed trust, respect and open communication in
building relationships are important.
- Many thought that short appointment times and dismissiveness were
common barriers.
- Participants believed that it is important to have strong self-advocacy
skills and/or a social support network that is able to advocate for you,
and ask the important questions.
- Nearly all informants agreed that patients need to know that they have
choices, and that this goes hand in hand with an even power dynamic
between patient and care provider.
- We will continue to work with the SHARP group and other stakeholders to consider
the findings of this study and their application in support of more meaningful
engagement of older patients in healthcare decision-making.
- Future phases of our work will involve the development and testing of tools and
resources to support meaningful patient engagement in primary care and other
healthcare settings.
Acknowledgements: This project was funded by
a Canadian Frailty Network Catalyst Grant. Many
thanks to the SHARP group for their ongoing
support and participation.
- Both challenges and opportunities for patient engagement in decision-making were identified.
- Key facilitators of engagement were respectful communication, and the establishment of trusting partnership relationships
between patients and healthcare providers.
- Barriers to engagement included time constraints of healthcare providers, and compromised capacity of patients and caregivers
due to illness and stress.
- Practical suggestions were made for how more meaningful patient engagement might be accomplished in resource-constrained
primary care settings.
- These findings are consistent with results of our recent knowledge synthesis on engagement of older adults in healthcare
decision-making.1
Methods
Results
Discussion Next Steps
Phase 1: Qualitative data collection
- A focus group interview (90 min) was conducted with our community research partnership group—Seniors
Helping as Research Partners (SHARP, n=7); this group included members with roles as family caregivers,
retired health care providers, and older adults.
- Key informant interviews (30-45 min) were also conducted with 3 primary care providers.
- Urban and rural participants were involved.
- The focus group and individual interviews were audio-recorded, then transcribed verbatim.
Phase 2: Data analysis
- The analysis involved coding responses as either barriers to, or facilitators of, engagement.
- This was followed by emergent coding to identify themes.
“My GP is absolutely
amazing. She listens to
me, she doesn’t mind if
I take a bit of extra
time…my biggest fear is
she’ll retire.” — SHARP
member 3
“Somehow or other it has
to get into the med school
curriculum.” — SHARP
member 2
“…it’s not a shameful thing to
change doctors or get a second
opinion. ” — SHARP member 4
“…there’s the prevention end of it…promoting [health]…not at an old
age, but at a young age and all through life.” — SHARP member 4
“…[maybe they’re] not even ready to go to meetings…[they could]
at least get in touch with people who would educate, so the doctor
doesn’t have to work alone...” — SHARP member 1
“I’m constantly having to fight and be really vocal and really stand up and
it worries me that a lot of people can’t do that.” — SHARP member 2
Supporting integrated and
coordinated care
Facilitating
patients’ self-
advocacy
Ongoing commitment to
prevention & health
management
Mutual respect between
patient and provider
Comprehensive healthcare
provider knowledge
Patients need to
know they have
choices
Working to build trust
Patient & Family Caregiver Perspectives
• Barriers to meaningful engagement:
• Lack of experience/awareness
• Inability to advocate and/or encourage self-advocacy
• Caregiver burnout
• Provider’s rushing/dismissiveness/ lack of empathy
• Limited resources
• Uneven provider-patient power dynamic
• Healthcare provider’s patronizing or use of complicated language
• Healthcare provider’s lack of knowledge
• Ageism/stereotyping
• Facilitators of meaningful engagement:
• Encouragement of self-education, self-advocacy skills &
commitment to health management
• Previous healthcare experience/awareness
• Respectful communication (e.g., listening, understanding needs)
• Even provider-patient power dynamic (open & honest dialogue)
• Improved care coordination & continuity of care
• Better accessibility
• Healthcare integration (e.g., family health teams)
Healthcare Provider Perspectives
• Barriers to meaningful engagement:
• Provider burnout & time constraints
• Struggle to obtain a comprehensive understanding of
patients’ circumstances
• Limited number of doctors & resources
• Inconsistent organizational policies
• Facilitators of meaningful engagement:
• Respectful communication, empathy & empowerment
• Encouraging patient in their commitment to health
management & gaining trust
• Even provider-patient power dynamic (open & honest
dialogue)
• Continued commitment to improving practical aspects of care
coordination, continuity of care & healthcare integration
• Better accessibility (e.g., funding, patient-centred policy)
• Encouragement of patient & self-education, advocacy skills &
commitment to health management
Major Themes:
Resolving the
challenges of time
constraints & heavy
workload
"...I just don’t have...a lot of the time
to sit down with them at that point in
time or [when] they’re getting to the
point that they’re too anxious or
something like that..."— Primary care
nurse 1
"...they’re worried that they’re going to be scored or
evaluated ...when you start to do the assessment they
ask: 'what is it for?' 'Is it going to identify me?' 'Is it going
to be coming back?' 'Is my doctor going to know about
that?'” — Primary care nurse 2
1Elliott J, McNeil H, Ashbourne J, Huson K, Boscart V, Stolee P. Engaging older adults in health care decision-making: A realist synthesis. The
Patient-Patient-Centered Outcomes Research. 2016 Apr 5:1-1.
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