JMIR Publications

ABSTRACT

Background:

Almost 40% of persons living with dementia (PLWDs) make an emergency department (ED) visit each year. One of the most impactful and costly elements of their ED care is the decision to discharge or admit them to the hospital- the “disposition” decision. When more than one reasonable option exists regarding a health care decision, such as the decision to admit or not, it often requires a complex conversation between patients, care ED partners, and ED providers, ideally involving shared decision-making (SDM). However, little is known about how these conversations are conducted, and the real-world context in which they take place. Best practices in ED communication and SDM for PLWDs and their care partners are limited.

Objective:

To characterize current practices in ED disposition conversations for PLWDs and their care partners, informed by perspectives from patient and care partner participants.

Methods:

This study will use an ethnographic design, including direct observation methods with a semi-structured data collection tool to capture the ED encounter for up to 20 patient and care partner dyads, including all discussions about dispositions. Follow up qualitative, semi-structured interviews will be conducted with PLWDs and their care partners to explore specific observations made during their ED encounter, and to gain insight into their perspective on their role and elements of decision support used during that conversation.

Results:

Data collection was initiated in October 2023, with 13 dyads recruited and observed as of July 2024. Further data collection is ongoing, and initial codebook refinement has started.

Conclusions:

Novel methods can offer novel insights. By combining direct observation and follow-up interviews about an ED visit, our study design will provide insights into how ED disposition occurs in real world settings for PLWDs. Findings can inform more patient-centered interventions for disposition decision making.