Family Involvement Hospital Ethnography

NCT ID: NCT06374992

Last Updated: 2024-09-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

32 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-05-02

Study Completion Date

2024-09-13

Brief Summary

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The goal of this observational study is to learn about the role of family members in caring for hospitalized older adults with cognitive impairment. The main questions it aims to answer are:

1. What features of the healthcare system facilitate or hinder family involvement in care from the perspective of patients, families, and healthcare workers?
2. How do hospital leaders understand the facilitators and barriers to family involvement?

Data collection will occur via semi-structure interviews, direct observation, and artifact analysis.

Detailed Description

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The investigators will use three complementary ethnographic approaches to achieve the study aims: direct observation (Aim 1); interviews with key informants (Aims 1 and 2); and analysis of artifacts such as policy documents related to visitation, care of cognitively impaired older adults, and family-centered care in the hospital (Aim 2).

AIM 1: To identify facilitators and barriers to family member involvement in the care of hospitalized older adults with cognitive impairment using in-context, semi-structured interviews and unobtrusive direct observation of patients, families, and healthcare workers. The investigators will employ participant observation and semi-structured interviews for each enrolled patient-family member dyad. For each dyad, the investigators will conduct two interviews, each lasting approximately 30-60 minutes. One interview will occur within 24 hours of admission ("entry interview") and one within 72 hours of discharge ("exit interview"). Both interviews will address how the participant (patient if able to contribute, and family member) perceive the family member in relation to the healthcare team and their experiences of involvement in care. Each dyadic patient/family interview will be conducted by the Principal Investigator or her delegate and digitally recorded, with the consent of participants, for subsequent transcription and analysis. In addition, three periods of direct observation will occur. Direct observations will focus on interactions between hospital staff, patients, and families, and what family members do during a patient's hospital stay. Observations will be recorded as field notes. Finally, the investigators will interview one to three healthcare workers (physicians, advanced practice providers, nurses) involved in the patient's care for each enrolled patient-family dyad. Healthcare worker interviews will take place either during the patient's hospitalization or within a week of the patient's discharge and may take place in person or remotely (phone or videoconference). Demographic and baseline data from the patient, family member, and healthcare workers that may affect family involvement will also be collected.

AIM 2: To understand hospital leadership perspectives on barriers to integration of family members into care for hospitalized older adult patients with cognitive impairment. For this aim, the investigators will conduct one-on-one interviews hospital leadership. After consent is obtained, study staff will conduct each interview using a semi-structured interview guide which queries topics on system-level facilitators and barriers to family involvement in the care of hospitalized older adults with cognitive impairment (e.g., visiting hour policies, rounding schedules). Aim 2 will also include an artifact analysis of policy documents related to visitation, care of cognitively impaired older adults, and family-centered care in the hospital.

Conditions

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Dementia

Study Design

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Observational Model Type

OTHER

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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Patient

Hospitalized older adults with cognitive impairment/dementia

No interventions assigned to this group

Family

Family member, friend, or neighbor involved in a hospitalization of an older adult motivated by a personal relationship rather than financial remuneration

No interventions assigned to this group

Healthcare Worker

Physicians, APPs, or nurses involved in the care of the patient with cognitive impairment/dementia

No interventions assigned to this group

Health system leader

Hospital executives, department chairs, division chiefs, nurse managers, medical directors, and other leaders within the health system.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Having a documented diagnosis of dementia or cognitive impairment
* Slated for admission to the hospital or admitted to the hospital
* Able to speak about the topics in the interview in English
* Capable of providing consent OR legally authorized representative (LAR) consents to patient's participation in study


* Age 18 or older
* Able to speak about the topics in the interview in English
* Is accompanying the patient slated for admission to the hospital or admitted to the hospital when the patient is approached, is the person the patient identifies as being the family member most involved in their hospital care, or is the emergency contact person for the patient listed in the medical record
* Willing to participate


* Age \>18
* Employed by Duke University Health System
* Physician, advanced practice provider (APP), or nurse on the care team of the patient with cognitive impairment
* Able to provide informed consent
* Willing to participate

Exclusion Criteria

* Incapable of providing informed consent
* Accompanying patient as a paid caregiver or aide


AIM 2:
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Duke University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Judith Vick, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Duke University

Locations

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Duke Regional Hospital

Durham, North Carolina, United States

Site Status

Countries

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United States

Other Identifiers

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Pro00114569

Identifier Type: -

Identifier Source: org_study_id

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