Hochschulschrift:
Dissertation, Universitätsmedizin der Universität Greifswald, 2023
Anmerkungen:
Literaturverzeichnis: Seite VI-XIV. - Literaturangaben
Kurzzusammenfassung in deutscher Sprache
Beschreibung:
Patient preferences, Person-Centered Care
Background & Aim: Person-Centered-Care (PCC) requires knowledge about patient preferences. Among People living with Dementia (PlwD) only limited evidence about patient preferences, more specifically quantitative preferences, is available. Additionally, data on congruence of patient preferences with physicians’ judgements are missing. Information on patient preferences and their congruence with physicians’ judgements is expected to support Shared Decision-Making and respectively support the implementation of PCC in dementia. The aim of this dissertation was to analyze patient preferences and physicians’ judgements for PCC, including an assessment of their congruence, based on data from the mixed-methods PreDemCare-study. (Funding: Doctoral Scholarship from the Hans & Ilse Breuer-Stiftung.) Methods: Development and conduct of a cross-sectional Analytic Hierarchy Process (AHP) survey with n=50 PlwD and n=25 physicians. Individual AHP-weights were calculated with the principal right eigenvector method and aggregated per group by Aggregation of Individual Priorities (AIP) mode. Individual consistency ratios (CRs) were calculated and aggregated per group. Group differences were analyzed descriptively by AIP-derived means and standard deviations of AHP-weights, resulting ranks, and boxplots. Additionally, differences between groups were investigated with independent paired t-tests or Mann Whitney-U tests. The sensitivity of AHP-results at the level of criteria was tested by an exclusion of inconsistent respondents in both groups, with an accepted threshold of the individual CR at ≤ 0.3 for PlwD and ≤ 0.2 for physicians. Results: Contrary to expectation, PlwD’s and physician’s ranking of AHP-elements did not differ meaningfully. Memory Exercises was the only AHP-criterion, for which a significant difference in AHP-weights could be identified (p-value = 0.01). After inconsistent participants had been excluded, no rank reversals occurred. At the level of criteria, the mean CR for PlwD was 0.261 and 0.181 for physicians, id est (i.e.) below the defined threshold. Conclusion: In the selected study setting of the PreDemCare-study, patient preferences and physicians’ judgements for elements of PCC in dementia aligned well, contrary to expectations. Subject to restrictions by small sample sizes, the findings may form a basis to guide the implementation of preference-based, person-centered dementia care.