Frail and Elderly Hospital Patients – The Challenge of Participation in Medical Decision Making

............................................................................................................................ 6 LIST OF PAPERS ................................................................................................................... 8 ABBREVIATIONS................................................................................................................. 9 FOREWORD.......................................................................................................................... 10 1 AIMS OF THE STUDY ................................................................................................ 12 OUTLINE............................................................................................................................... 13 2 BACKGROUND............................................................................................................ 14 2.1 Background factors......................................................................................... 14 2.1.1 Demographics and care utilization by the elderly in hospital settings ... 14 2.2 The elderly patient ......................................................................................... 16 2.2.1 The concept of “frailty” – our object of study ............................................. 16 2.2.2 The remuneration system of health care and diagnosis‐based care (DBC) versus situation‐based care (SBC). ............................................................................. 17 2.3 Patient participation in medical decision making ................................... 20 2.3.1 Definitions and importance............................................................................ 20 2.3.2 Models and taxonomies on patient participation ....................................... 21 2.3.3 Obstacles to frail‐elderly patient participation in medical decision making............................................................................................................................ 24 2.4 Rationale........................................................................................................... 25 3 MATERIAL AND METHODS ................................................................................... 26 3.1 Sampling .......................................................................................................... 27 3.2 Setting and data collection............................................................................ 28 3.3 Data analysis.................................................................................................... 31 3.3.1 Qualitative methods ........................................................................................ 31 3.3.2 Statistical methods........................................................................................... 33 3.3.3 Integration of results ....................................................................................... 34 3.3.4 Validity and rigour .......................................................................................... 34 3.4 Ethical Considerations................................................................................... 35 4 RESULTS ........................................................................................................................ 37 4.1 Patient participation....................................................................................... 37