Caitlin Deery, Kerry Hwang, Grace Marconi, Maneesh Prasad, Kelly Ottosen, Stephanie M Garratt, Pauline Wong, Elizabeth Manias
Families rarely received an invitation to participate in medication decision-making, highlighting how preferences for active engagement are difficult to address under current practices. Policymakers should consider strategies that promote shared decision-making, such as mandating that alternative treatment options are provided where clinically appropriate.
BACKGROUND: Amid healthcare workforce shortages and an aging population, families are increasingly performing informal caregiving tasks, equipping them with skills unique to their older relative's medications. Yet, despite high rates of medication errors during transitions of care, family members' expertise is rarely solicited by healthcare professionals in hospital.
PURPOSE: To understand how families are engaged in older adults' medication management, and to explore strategies for improving medication management during transitions of care.
METHODS: A qualitative exploratory study was conducted between October 2024 and January 2025. Semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using the Framework Method. Inductive themes were conceptualized from the data and deductively mapped to the Patient and Family Engagement Framework.
RESULTS: In total, 66 semi-structured interviews were conducted. Eight inductive themes were generated from the data and deductively mapped to three levels of engagement comprising consultation, involvement, and partnership and shared leadership. Four themes mapped onto consultation, with family members mainly receiving and transferring medication information between healthcare professionals. Three themes reflected involvement, where healthcare professionals considered family members' preferences when determining the treatment options. At this level of engagement, responsibility for managing medications was delegated between families and healthcare professionals. The last theme aligned with partnership and shared leadership, where families initiated medication changes and negotiated treatment plans with healthcare professionals. An application or QR code was proposed as a strategy to improve medication information transfer. Family members also believed that being offered alternative treatments and a list of possible medication questions to ask would enhance collaborative decision-making.
CONCLUSION: Families rarely received an invitation to participate in medication decision-making, highlighting how preferences for active engagement are difficult to address under current practices. Policymakers should consider strategies that promote shared decision-making, such as mandating that alternative treatment options are provided where clinically appropriate.
REGISTRATION: Registered in ANZCTR (ACTRN12624000901505) on the 24th of July 2024.