Elderly patients care trajectories from the perspectives of patients, next of kin and health care professionals: A qualitative case study

Abstract

An increasing number of elderly people are living longer with chronic illnesses. Many need healthcare from different health care professionals at various levels in the health care services. It is known that patient and next of kin experience the services incoherent and fragmented and health professionals strive to provide coherent and person-centered healthcare. To get an in-depth understanding of the challenges and issues regarding the care trajectory where several actors are involved it is emphasized that the perspectives from patient, next of kin and health professional need to be included. The aim of this thesis was to explore and describe the care trajectory for elderly patients with complex healthcare needs from their hospitalization to their return to primary care as it is experienced from the patient, next of kin and health care professional involved. The patients were followed through their care trajectory from their hospital stay, during discharge and after being discharged to the municipalities. In a multiple-case study participation observations and interviews were used as methods, in addition to extracted data from the patients’ records. The main findings show that the patient and next of kin´s decisions and choices for further follow up during and after the hospital stay were part of a long term and continuous process that included conditions about life otherwise. For healthcare professionals the differences between patient’s long-term needs and organizational requirements led to challenges in providing person-centered healthcare. The thesis reveals that one must facilitate the time and space needed by the patient and next of kin to make decisions with a long-term perspective in mind. This means that the patient’s considerations about decisions and choices must be seen in the light of their life in general.