To explore physicians' thoughts and considerations of participation in medical decision making by hospitalised elderly patients.
A qualitative study using focus group interviews with physicians interpreted with grounded theory and completed with a questionnaire.
Setting and participants
The setting was three different hospitals in two counties in Sweden. Five focus groups were conducted with physicians (n=30) in medical departments, with experience of care of elderly patients.
Physicians expressed frustration at not being able to give good care to elderly patients with multimorbidity, including letting them participate in medical decision making. Two main categories were found: ‘being challenged’ by this patient group and ‘being a small part of the healthcare production machine’. Both categories were explained by the core category ‘lacking in time’. The reasons for the feeling of ‘being challenged’ were explained by the subcategories ‘having a feeling of incompetence’, ‘having to take relatives into consideration’ and ‘having to take cognitive decline into account’. The reasons for the feeling of ‘being a small part of the healthcare production machine’ were explained by the subcategories ‘at the mercy of routines’ and ‘inadequate remuneration system’, both of which do not favour elderly patients with multimorbidity.
Physicians find that elderly patients with multimorbidity lead to frustration by giving them a feeling of professional inadequacy, as they are unable to prioritise this common and rapidly growing patient group and enable them to participate in medical decision making. The reason for this feeling is explained by lack of time, competence, holistic view, appropriate routines and proper remuneration systems for treating these patients.
Physicians' views and attitudes to elderly patients' participation in medical decision making.
Hospital care is not well adapted to elderly patients with multimorbidity as they are a highly complex patient group to take care of.
Taking care of elderly patients with multimorbidity often frustrates physicians by giving them a feeling of professional inadequacy.
Remuneration systems do not allow for necessary time for communication among medical professionals and between physicians and patients or relatives. Neither do these systems support the necessary integration of care.
Strengths and limitations of this study
The scope of the study, to the authors' knowledge, has not been clearly documented in earlier studies and is important to bear in mind when planning for future healthcare, especially as there will be a growing proportion of frail elderly people.
Qualitative research limits generalization.
The study was performed in a Swedish context.