GEAR 2.0 Priorities – Communications and Decision-Making
The key components of Emergency Department (ED) communication remain largely undefined, but existing research on ED communication in non-dementia populations demonstrates a suboptimal level of information exchange. Dementia may add layers of complexity to current ED communication strategies. This complexity must be addressed to ensure that patients and their care partners feel a part of the care process. Strategies employed by surgical medicine, particularly those that use patient values to drive patient-centered medicine practices, can be applied to ED care to improve communication for people living with dementia (PLWD). These strategies involve engaging every vital participant in clinical care: the patient, care partners, and the clinicians.
The Communications and Decision-Making Work Group identified two Patient Intervention Comparison Outcomes (PICO) questions to guide their literature review of publications related to communications and decision-making in the ED and other clinical settings.
- PICO-1: How does communication and decision-making differ for PLWD compared to persons without dementia?
- Population: ED patients ≥ 65 years old
- Intervention: Efforts to evaluate communication or medical information exchange between ED healthcare teams and patients/care partners
- Comparison: Standard processes and procedures for communication between patients, families, caregivers and the ED team
- Outcomes: Differences between patients with and without dementia in communication effectiveness, admission rates, ED returns after 3 days and 30 days, and patient, caregiver, and provider experience
- PICO-2: Are there specific medical communication strategies (e.g., Teach-back or nextday phone follow-up) that improve the process or outcomes of ED care in PLWD?
- Population: ED patients ≥ 65 years old with known or suspected dementia or cognitive impairment discharged from the ED
- Intervention: Augmented communication efforts
- Comparison: Standard processes and procedures for communication between patients, families, caregivers and the ED team
- Outcomes: Comprehension of discharge instructions and 24-hour recall of ED discharge instructions, ED returns at 24 hours and 30 days, hospital admissions at 1 week, and change in living situation at 3 months
Top Research Priority Areas
The top voted communication and decision-making research priority areas ranked during the 2021 GEAR 2.0 Consensus Conference based on the scoping reviews are as follows:
- What are the barriers and facilitators of effective communication with persons living with dementia (or their care partners) during an episode of ED care, with attention to actionable elements/ideas?
- What are valid and reliable measures or outcomes of "effective (short and long-term) communication" in patients with dementia?
- What are the best practices (when/how) for engagement of care partners in care decision-making in the ED?
- How do individual, provider, and system-level factors that influence communication for ED PLWD or their care partners? (e.g., ethnic, gender, and socioeconomic factors or conscious or unconscious biases.)
- How can each member of the ED care team (e.g., social workers, physicians, technicians, nurses, etc.) ensure high quality communication with PLWD, care partners, and other team members?