THE DEEDS PROJECTTHE DEEDS PROJECT

Professionals’ perceptions of patient Professionals’ perceptions of patient involvementinvolvement

Rosemary ChessonRosemary Chesson

The Robert Gordon UniversityThe Robert Gordon University

AcknowledgementsAcknowledgements

All study participantsAll study participants Lesley AdamsLesley Adams Project Steering GroupProject Steering Group Grampian Primary Care Trust Clinical Grampian Primary Care Trust Clinical

GovernanceGovernance

FundingFunding

The Wider ContextThe Wider Context

Patient Focus and

Public Involvement

Government policies

Demographic trends

Changes in attitudes towards

disabilities

Consumerist society

Scientific & technological

advancesChanges in delivery of

health & social care services

Research

DEEDS ProjectDEEDS Project

Main AimMain Aim

To develop and evaluate educational To develop and evaluate educational developmentdevelopment

strategies to support patient involvementstrategies to support patient involvement

[research to underpin development strategy][research to underpin development strategy]

Key objectivesKey objectives

establish staffs’ interpretations of involvementestablish staffs’ interpretations of involvement provide baseline data on professionals’ views provide baseline data on professionals’ views

of patient involvementof patient involvement identify barriers to patient involvementidentify barriers to patient involvement

Study designStudy design

Selection of 2 LHCCs

(Central Aberdeenshire & Aberdeen & North)

Random selection of qualified staff

Interviews & Focus Groups

Data analysis, draft report, feedback

Study participantsStudy participants

205 invited 92 participated205 invited 92 participated Participants included:Participants included:

AHPsAHPs

GPsGPs

MidwivesMidwives

DNs, HVs, PNs, LNsDNs, HVs, PNs, LNs

RGNs & SENs (community hospital)RGNs & SENs (community hospital)

Practice managersPractice managers

Data collectionData collection

Qualitative methodsQualitative methods

interviewsinterviews focus groupsfocus groups small group discussionsmall group discussion Tape-recording and transcriptionTape-recording and transcription

FindingsFindings

Definitions of involvementDefinitions of involvement

responses covered a broad spectrumresponses covered a broad spectrum some staff (especially GPs) saw patient some staff (especially GPs) saw patient

involvement encompassing one-to-one clinical involvement encompassing one-to-one clinical consultations to large scale consultation consultations to large scale consultation exercises.exercises.

many related the term solely to public many related the term solely to public involvement involvement

language reflected need for professional consent language reflected need for professional consent for patient involvementfor patient involvement

in rural areas, some staff felt professionals could in rural areas, some staff felt professionals could act as proxies for patientsact as proxies for patients

What does patient involvement What does patient involvement mean?mean?

‘‘patients being informed, communicated with and youpatients being informed, communicated with and you

know, maybe having a say ...... us listening to them’know, maybe having a say ...... us listening to them’

Practice ManagerPractice Manager

‘‘well, patient involvement ... to me the thing that springs to mindwell, patient involvement ... to me the thing that springs to mind

is focus groups’is focus groups’

NurseNurse

‘‘probably allowing patients to give their opinions’probably allowing patients to give their opinions’

GPGP

‘‘Its getting them to make decisions and understanding that’s theIts getting them to make decisions and understanding that’s the

only way, and, well, for them to understand what the problem is,only way, and, well, for them to understand what the problem is,

as opposed to saying take this and you’ll be okay’as opposed to saying take this and you’ll be okay’

GPGP

To what extent should patients be To what extent should patients be involved in decision making?involved in decision making?

responses focused on current situationresponses focused on current situation mostly discussed in terms of public mostly discussed in terms of public

involvementinvolvement

lack of continuity in involvement activitieslack of continuity in involvement activities

general perception patients not general perception patients not significantlysignificantly

involved (belief most are involved (belief most are apathetic/unwilling)apathetic/unwilling)

Should patients be involved?Should patients be involved?

Conditional on:Conditional on:

ageage educationeducation disabilitiesdisabilities The PATIENT’S BEST INTERESTThe PATIENT’S BEST INTEREST

Should patients be involved?Should patients be involved?

‘‘I think it would very much depend on the patient’I think it would very much depend on the patient’

Practice Practice ManagerManager

‘‘it depends on their depth of knowledge’it depends on their depth of knowledge’

Health VisitorHealth Visitor

‘‘I think they should be fully allowed, as long as they knowI think they should be fully allowed, as long as they know

the pros and cons of their decision’the pros and cons of their decision’ NurseNurse

‘‘it is difficult when we’ve got this duty of care ......’it is difficult when we’ve got this duty of care ......’

NurseNurse

Barriers to patient involvementBarriers to patient involvement

some staff saw no barrierssome staff saw no barriers more commonly, several identifiedmore commonly, several identified

- time- time

- finance- finance

- lack of skills- lack of skills

- previous training and experience- previous training and experience

- lack of strategic direction- lack of strategic direction

Training and experienceTraining and experience

‘‘we were brought up to stay in control, you had to we were brought up to stay in control, you had to

inspire confidence’inspire confidence’ Health VisitorHealth Visitor

‘‘I think we were trained to hold onto power, definitely. There’sI think we were trained to hold onto power, definitely. There’s

this whole thing about sharing power and giving power asthis whole thing about sharing power and giving power as

opposed to enabling a person. (you need to look) as if you areopposed to enabling a person. (you need to look) as if you are

in control always and not make the patient feel ... you werein control always and not make the patient feel ... you were

unsure and create an air of uncertainty’unsure and create an air of uncertainty’

Health VisitorHealth Visitor

‘‘I think we have to change our service to suit the people we I think we have to change our service to suit the people we areare

treating. For many years we have just served ourselves and treating. For many years we have just served ourselves and

thought about ourselves’thought about ourselves’ AHPAHP

Changing behaviourChanging behaviour

‘‘I think it’s nice to listen to other people’s opinions ...I think it’s nice to listen to other people’s opinions ...

But I don’t know that it would actually change what I did in aBut I don’t know that it would actually change what I did in a

consulting room ...(as) we’ve been GPs for 20 years. I’m notconsulting room ...(as) we’ve been GPs for 20 years. I’m not

saying you can't change that, but it would be unlikely though’saying you can't change that, but it would be unlikely though’

GPGP

‘‘I think the biggest training thing would be how to actuallyI think the biggest training thing would be how to actually

consult with them. Not so much (about) a meeting ... aconsult with them. Not so much (about) a meeting ... a

questionnaire but maybe attitude change, behaviour changequestionnaire but maybe attitude change, behaviour change

and the skill of doing it’and the skill of doing it’

Lead NurseLead Nurse

Changing behaviour cont....Changing behaviour cont....

‘‘I don’t know if we’ve changed as much as the patients I don’t know if we’ve changed as much as the patients have ...have ...

I don’t know if its changed that dramatically to what the I don’t know if its changed that dramatically to what the patientspatients

have. Maybe that’s the problem’have. Maybe that’s the problem’

Practice Practice ManagerManager

Implications for:Implications for:

patient/professional relationshipspatient/professional relationships

practice across professions/specialismspractice across professions/specialisms

identifying the needs of more ‘challenging’ groups of identifying the needs of more ‘challenging’ groups of patientspatients

future researchfuture research

other policy agenda i.e. social inclusionother policy agenda i.e. social inclusion

future education and trainingfuture education and training